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1.
Rev. enferm. UERJ ; 28: e50968, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1122751

RESUMO

Objetivo: descrever as práticas culturais de cuidado no puerpério de mulheres quilombolas. Método: estudo descritivo, de abordagem qualitativa e delineado por meio da Teoria da Diversidade e Universalidade do Cuidado de Madeleine Leininger. Participaram do estudo quatorze mulheres quilombolas que já tinham vivenciado o período puerperal. A coleta das informações ocorreu de junho a setembro de 2018. Projeto aprovado por Comitê de Ética em Pesquisa. Resultados: observou-se a manutenção das crenças e valores, considerando a cultura local relacionada às práticas de cuidado de puérperas quilombolas. Considerações finais: as práticas de cuidado desenvolvidas por mulheres quilombolas no pós-parto se caracterizam por receber influência das crenças, valores e modos de vida que foram transmitidas por meio da oralidade por outras mulheres que já tinham vivenciado esse período.


Objective: to describe cultural practices of health care for quilombola women in puerperium. Method: this qualitative, descriptive study was framed by Madeleine Leininger's Theory of Culture Care Diversity and Universality. Fourteen quilombola women who had already experienced the puerperal period participated in the study. Information was collected from June to September 2018. The project was approved by the research ethics committee. Results: beliefs and values were observed to be maintained in the local culture as regards practices of care for puerperal quilombola women. Final considerations: the postpartum care practices applied by quilombola women were characteristically influenced by the beliefs, values and ways of life transmitted orally by other women who had already experienced puerperium.


Objetivo: describir las prácticas culturales de atención a la salud de las mujeres quilombolas en el puerperio. Método: este estudio cualitativo y descriptivo fue enmarcado por la Teoría de la Cultura Cuidado de la Diversidad y Universalidad de Madeleine Leininger. Participaron del estudio catorce mujeres quilombolas que ya habían pasado por el puerperio. La información se recopiló de junio a septiembre de 2018. El proyecto fue aprobado por el comité de ética en investigación. Resultados: se observó el mantenimiento de creencias y valores en la cultura local en cuanto a prácticas de cuidado de las puérperas quilombolas. Consideraciones finales: las prácticas de atención posparto aplicadas por las mujeres quilombolas estuvieron característicamente influenciadas por las creencias, valores y formas de vida transmitidas oralmente por otras mujeres que ya habían experimentado el puerperio.


Assuntos
Humanos , Feminino , Grupos Étnicos , Características Culturais , Período Pós-Parto , Saúde Materna , Repouso em Cama , Brasil , Higiene , Epidemiologia Descritiva , Pesquisa Qualitativa , Comportamento Alimentar , Normas Sociais
2.
Artigo em Inglês | PAHO-IRIS | ID: phr-53012

RESUMO

[ABSTRACT]. Objective. To assess coverage and inequalities in maternal and child health interventions among Haitians, Haitian migrants in the Dominican Republic and Dominicans. Methods. Cross-sectional study using data from nationally representative surveys carried out in Haiti in 2012 and in the Dominican Republic in 2014. Nine indicators were compared: demand for family planning satisfied with modern methods, antenatal care, delivery care (skilled birth attendance), child vaccination (BCG, measles and DPT3), child case management (oral rehydration salts for diarrhea and careseeking for suspected pneumonia), and the composite coverage index. Wealth was measured through an asset-based index, divided into tertiles, and place of residence (urban or rural) was established according to the country definition. Results. Haitians showed the lowest coverage for demand for family planning satisfied with modern methods (44.2%), antenatal care (65.3%), skilled birth attendance (39.5%) and careseeking for suspected pneumonia (37.9%), and the highest for oral rehydration salts for diarrhea (52.9%), whereas Haitian migrants had the lowest coverage in DPT3 (44.1%) and oral rehydration salts for diarrhea (38%) and the highest in careseeking for suspected pneumonia (80.7%). Dominicans presented the highest coverage for most indicators, except oral rehydration salts for diarrhea and careseeking for suspected pneumonia. The composite coverage index was 79.2% for Dominicans, 69.0% for Haitian migrants, and 52.6% for Haitians. Socioeconomic inequalities generally had pro-rich and pro-urban pattern in all analyzed groups. Conclusion. Haitian migrants presented higher coverage than Haitians, but lower than Dominicans. Both countries should plan actions and policies to increase coverage and address inequalities of maternal health interventions.


[RESUMEN]. Objetivo. Evaluar la cobertura y las desigualdades en las intervenciones de salud maternoinfantil entre haitianos, migrantes haitianos en la República Dominicana y dominicanos. Métodos. Estudio transversal con datos de encuestas representativas a nivel nacional realizadas en Haití en 2012 y en la República Dominicana en 2014. Se compararon nueve indicadores: demanda de planificación familiar satisfecha con métodos modernos, atención prenatal, atención del parto (por personal de salud calificado), vacunación infantil (BCG, sarampión y DPT3), gestión de casos de enfermedad en la infancia (administración de sales de rehidratación oral para la diarrea y búsqueda de atención sanitaria ante la sospecha de neumonía), e índice de cobertura compuesto. La riqueza se midió mediante un índice basado en los activos, dividido en terciles, y el lugar de residencia (urbano o rural) se determinó según la definición del país. Resultados. La población haitiana mostró la menor cobertura respecto de la demanda de planificación familiar satisfecha con métodos modernos (44,2%), atención prenatal (65,3%), asistencia calificada en el parto (39,5%) y búsqueda de atención sanitaria ante la sospecha de neumonía (37,9%), y la mayor respecto de la administración de sales de rehidratación oral para la diarrea (52,9%); los migrantes haitianos presentaron la menor cobertura en DPT3 (44,1%) y la administración de sales de rehidratación oral para la diarrea (38%) y la mayor en la búsqueda de atención sanitaria ante la sospecha de neumonía (80,7%). La población dominicana presentó la cobertura más alta en la mayoría de los indicadores, excepto en la administración de sales de rehidratación oral para la diarrea y en la búsqueda de atención sanitaria ante la sospecha de neumonía. El índice de cobertura compuesto fue de 79,2% para los dominicanos, 69,0% para los migrantes haitianos y 52,6% para los haitianos. Las desigualdades socioeconómicas generalmente tenían un patrón prorrico y prourbano en todos los grupos analizados. Conclusión. Los migrantes haitianos en la República Dominicana presentaron una mayor cobertura que la población haitiana residente en Haití, pero menor que la población dominicana. Ambos países deberían planificar acciones y políticas para aumentar la cobertura y abordar las desigualdades existentes en las intervenciones de salud materna.


Assuntos
Migração Humana , Saúde Materna , Saúde da Criança , Disparidades em Assistência à Saúde , Haiti , República Dominicana , Migração Humana , Saúde Materna , Saúde da Criança , Disparidades em Assistência à Saúde , Haiti , República Dominicana
3.
Epidemiol Psychiatr Sci ; 29: e174, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33070789

RESUMO

AIMS: Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). METHODS: We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. RESULTS: We identified 21 trials with 28 284 mother-child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13-1.71, ten trials, N = 4749 mother-child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02-0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. CONCLUSIONS: These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.


Assuntos
Aleitamento Materno/psicologia , Transtornos Mentais/psicologia , Saúde Mental/estatística & dados numéricos , Relações Mãe-Filho/psicologia , Criança , Filho de Pais Incapacitados , Países em Desenvolvimento , Feminino , Humanos , Masculino , Saúde Materna , Apego ao Objeto , Pobreza
4.
PLoS One ; 15(10): e0238776, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33035242

RESUMO

Globally, increasing efforts have been made to hold duty-bearers to account for their commitments to improve reproductive, maternal, newborn, child and adolescent health (RMNCAH) over the past two decades, including via social accountability approaches: citizen-led, collective processes for holding duty-bearers to account. There have been many individual studies and several reviews of social accountability approaches but the implications of their findings to inform future accountability efforts are not clear. We addressed this gap by conducting a review of reviews in order to summarise the current evidence on social accountability for RMNCAH, identify factors contributing to intermediary outcomes and health impacts, and identify future research and implementation priorities. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42019134340). We searched eight databases and systematic review repositories and sought expert recommendations for published and unpublished reviews, with no date or language restrictions. Six reviews were analysed using narrative synthesis: four on accountability or social accountability approaches for RMNCAH, and two specifically examining perinatal mortality audits, from which we extracted information relating to community involvement in audits. Our findings confirmed that there is extensive and growing evidence for social accountability approaches, particularly community monitoring interventions. Few documented social accountability approaches to RMNCAH achieve transformational change by going beyond information-gathering and awareness-raising, and attention to marginalised and vulnerable groups, including adolescents, has not been well documented. Drawing generalisable conclusions about results was difficult, due to inconsistent nomenclature and gaps in reporting, particularly regarding objectives, contexts, and health impacts. Promising approaches for successful social accountability initiatives include careful tailoring to the social and political context, strategic planning, and multi-sectoral/multi-stakeholder approaches. Future primary research could advance the evidence by describing interventions and their results in detail and in their contexts, focusing on factors and processes affecting acceptability, adoption, and effectiveness.


Assuntos
Saúde , Responsabilidade Social , Adolescente , Saúde do Adolescente , Criança , Saúde da Criança , Participação da Comunidade , Feminino , Humanos , Saúde do Lactente , Recém-Nascido , Masculino , Saúde Materna , Determinação de Necessidades de Cuidados de Saúde , Mortalidade Perinatal , Gravidez , Saúde Reprodutiva
5.
RECIIS (Online) ; 14(3): 656-680, jul.-set. 2020. graf, tab
Artigo em Português | LILACS | ID: biblio-1121855

RESUMO

A pesquisa apresentada neste artigo realizou um balanço quantitativo da taxa de mortalidade materna no Brasil ao longo das últimas duas décadas (2000-2019), sob o recorte de cor/raça com o objetivo de enfatizar a importância da divulgação de informações como demarcadores de mensuração de desigualdades raciais na mortalidade materna de mulheres negras no período gestacional, durante o parto e puerpério. A metodologia compreende a desagregação por cor/raça de dados do Sistema Único de Saúde (MS/DataSUS) derivados do Sistema de Informação de Mortalidade (SIM), a fim de coletar dados referentes a óbitos maternos, e do Sistema de Nascidos Vivos (Sinasc) para os dados relacionados aos nascimentos informados em território nacional. Os resultados obtidos apontam uma tendência de índices de mortalidade materna entre mulheres de cor/raça preta substancialmente maiores do que os que se referem às de cor/raça branca, revelando a falta de informações e políticas que minimizem a condição de vulnerabilidade de alguns grupos étnico-raciais no sistema de atenção à saúde materna.


This article presents a quantitative research examining the color/race-related maternal mortality rate in Brazil over the last two decades (2000-2019), aiming to emphasize the importance of the disclosure of information as indicators of racial inequalities in the black women' maternal mortality in the gestational period, during the childbirth and puerperium. The methodology uses the disaggregation by color/race of data from the Sistema Único de Saúde (DataSUS - Unified Health System) derived from the SIM - Sistema de Informação de Mortalidade (Mortality Information System), in order to collect data related to maternal deaths and from the Sinasc - Sistema de Nascidos Vivos (Live Births System), for the data related to births registered in the national territory. The results obtained point to a trend towards the maternal mortality rates being substantially higher among Black race/color women than among White race/color women, revealing the lack of information and policies that minimize the vulnerability of some ethnic-racial groups in the maternal health care system.


Este artículo presenta una investigación cuantitativa acerca de la tasa de mortalidad materna en Brasil a lo largo de las dos últimas décadas (2000-2019), del punto de vista de color/raza con el objetivo de enfatizar la importancia de la divulgación de informaciones como indicadores de las desigualdades raciales en la mortalidad materna de las mujeres negras en la fase de gestación, en el momento del parto y en el período de puerperio. La metodología utiliza la desagregación por color/raza de los datos del Sistema Único de Saúde (DataSUS - Sistema Unificado de Salud) derivados del SIM - Sistema de Informação de Mortalidade (Sistema de Información sobre Mortalidad), con el fin de recopilar datos relacionados con las muertes maternas, y del Sinasc - Sistema de Nascidos Vivos (Sistema de Nacidos Vivos) para los datos relacionados con los nacimientos documentados en el territorio nacional. Los resultados obtenidos apuntan una tendencia de las tasas de mortalidad materna entre las mujeres de color/raza negra sustancialmente superior a de las mujeres de color/raza blanca, revelando la falta de información y políticas que minimicen la condición de vulnerabilidad de ciertos grupos étnico-raciales en el sistema de atención de salud materna.


Assuntos
Humanos , Morte Materna , Sistemas de Informação em Saúde , Saúde Materna , Análise de Dados , Brasil , Grupos de Populações Continentais , Nascimento Vivo , Racismo
7.
Lancet Public Health ; 5(11): e624-e627, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32971008

RESUMO

Resilient societies respond rapidly and effectively to health challenges and the associated economic consequences, and adapt to be more responsive to future challenges. Although it is only possible to recognise resilience retrospectively, the COVID-19 pandemic has occurred at a point in human history when, uniquely, sufficient knowledge is available on the early-life determinants of health to indicate clearly that a focus on maternal, neonatal, and child health (MNCH) will promote later resilience. This knowledge offers an unprecedented opportunity to disrupt entrenched strategies and to reinvest in MNCH in the post-COVID-19 so-called new normal. Furthermore, analysis of the short-term, medium-term, and longer-term consequences of previous socioeconomic shocks provides important insights into those domains of MNCH, such as neurocognitive development and nutrition, for which investment will generate the greatest benefit. Such considerations apply to high-income countries (HICs) and low-income and middle-income countries (LMICs). However, implementing appropriate policies in the post-COVID-19 recovery period will be challenging and requires political commitment and public engagement.


Assuntos
Saúde da Criança/economia , Infecções por Coronavirus/epidemiologia , Saúde Global/economia , Saúde do Lactente/economia , Saúde Materna/economia , Pneumonia Viral/epidemiologia , Criança , Feminino , Humanos , Recém-Nascido , Pandemias , Gravidez
8.
PLoS One ; 15(9): e0238938, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936823

RESUMO

BACKGROUND: Despite having the high rate of stillbirth in most of the countries of South Asia, there is a lack of synthesized evidence based on factors associated with stillbirth. This study systematically synthesizes the evidence on factors associated with stillbirth in the four selected countries of South Asia. METHODS: This review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies that examined factors associated with stillbirth in South Asia were searched using five major electronic search databases including MEDLINE, CINAHL, Embase, PsycINFO, and Scopus, published between January 2000 and December 2019. In the meta-analysis, significant heterogeneity was detected among studies (I2 >50%), and hence a random effect model was used. RESULTS: A total of 20 studies met the inclusion criteria. The pooled rate of stillbirth from the studies in Bangladesh, India, Nepal, and Pakistan was 25.15 per 1000 births. Pregnancy complications, maternal health conditions, fetal complications, lack of antenatal care, and lower Socio Economic Status (SES) were the most common factors associated with stillbirth in countries of South Asia. CONCLUSION: This study confirmed that stillbirth in selected countries of South Asia remains high. To reduce stillbirth, a greater focus needs to be on timely management of preterm labor, maternal hypertension, and provision of financial support for quality antenatal and delivery care. The interventions should be targeted for women living in remote areas, who are less educated and those with low SES.


Assuntos
Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Natimorto/epidemiologia , Bangladesh/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Recém-Nascido , Masculino , Saúde Materna , Nepal/epidemiologia , Estudos Observacionais como Assunto , Paquistão/epidemiologia , Gravidez , Medição de Risco
9.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817396

RESUMO

BACKGROUND: Severe maternal morbidity (SMM) comprises an array of conditions and procedures denoting an acutely life-threatening pregnancy-related condition. SMM may further compromise fetal well-being. Empirical data are lacking about the relation between SMM and infant mortality. METHODS: This population-based cohort study included 1 892 857 singleton births between 2002 and 2017 in Ontario, Canada, within a universal health care system. The exposure was SMM as an overall construct arising from 23 weeks' gestation up to 42 days after the index delivery. The primary outcome was infant mortality from birth to 365 days. Multivariable modified Poisson regression generated relative risks and 95% confidence intervals (CIs), adjusted for maternal age, income, rurality, world region of origin, diabetes mellitus, and chronic hypertension. RESULTS: Infant mortality occurred among 174 of 19 587 live births with SMM (8.9 per 1000) vs 5289 of 1 865 791 live births without SMM (2.8 per 1000) (an adjusted relative risk of 2.93 [95% CI 2.51-3.41]). Of 19 587 pregnancies with SMM, 4523 (23.1%) had sepsis. Relative to births without SMM, the adjusted odds ratio for infant death from sepsis was 1.95 (95% CI 1.10-3.45) if SMM occurred without maternal sepsis and 6.36 (95% CI 3.50-11.55) if SMM included sepsis. CONCLUSIONS: SMM confers a higher risk of infant death. There is also coupling tendency (concurrent event of interest) between SMM with sepsis and infant death from sepsis. Identification of preventable SMM indicators, as well as the development of strategies to limit their onset or progression, may reduce infant mortality.


Assuntos
Mortalidade Infantil/tendências , Saúde Materna/tendências , Complicações na Gravidez/epidemiologia , Índice de Gravidade de Doença , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Morbidade , Ontário/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Adulto Jovem
10.
Public Health Rep ; 135(5): 658-667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32805192

RESUMO

OBJECTIVES: The health profile of Arab American mothers and infants may differ from that of non-Arab American mothers and infants in the United States as a result of social stigma experienced in the historical and current sociopolitical climate. The objective of our study was to compare maternal health behaviors, maternal health outcomes, and infant health outcomes of Arab American mothers and non-Hispanic white mothers in Massachusetts and to assess the role of nativity as an effect modifier. METHODS: Using data from Massachusetts birth certificates (2012-2016), we conducted adjusted logistic and linear regression models for maternal health behaviors, maternal health outcomes, and infant health outcomes. We used Arab ethnicity as the exposure of interest and nativity as an effect modifier. RESULTS: Arab American mothers had higher odds than non-Hispanic white mothers of initiating breastfeeding (adjusted odds ratio [aOR] = 2.61; 95% CI, 2.39-2.86), giving birth to small-for-gestational-age infants (aOR = 1.28; 95% CI, 1.18-1.39), and having gestational diabetes (aOR = 1.31; 95% CI, 1.20-1.44). Among Arab American mothers, non-US-born mothers had higher odds than US-born mothers of having gestational diabetes (aOR = 1.80; 95% CI, 1.33-2.44) and lower odds of initiating prenatal care in the first trimester (aOR = 0.41; 95% CI, 0.33-0.50). In linear regression models, infants born to non-US-born Arab American mothers weighed 42.1 g (95% CI, -75.8 to -8.4 g) less than infants born to US-born Arab American mothers. CONCLUSION: Although Arab American mothers engage in positive health behaviors, non-US-born mothers had poorer maternal health outcomes and access to prenatal care than US-born mothers, suggesting the need for targeted interventions for non-US-born Arab American mothers.


Assuntos
Árabes/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Saúde do Lactente/estatística & dados numéricos , Comportamento Materno/psicologia , Saúde Materna/estatística & dados numéricos , Mães/psicologia , Características de Residência/estatística & dados numéricos , Adulto , Árabes/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Massachusetts , Mães/estatística & dados numéricos
12.
Cochrane Database Syst Rev ; 8: CD013679, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32813276

RESUMO

BACKGROUND: The global burden of poor maternal, neonatal, and child health (MNCH) accounts for more than a quarter of healthy years of life lost worldwide. Targeted client communication (TCC) via mobile devices (MD) (TCCMD) may be a useful strategy to improve MNCH. OBJECTIVES: To assess the effects of TCC via MD on health behaviour, service use, health, and well-being for MNCH. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials that assessed TCC via MD to improve MNCH behaviour, service use, health, and well-being. Eligible comparators were usual care/no intervention, non-digital TCC, and digital non-targeted client communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. MAIN RESULTS: We included 27 trials (17,463 participants). Trial populations were: pregnant and postpartum women (11 trials conducted in low-, middle- or high-income countries (LMHIC); pregnant and postpartum women living with HIV (three trials carried out in one lower middle-income country); and parents of children under the age of five years (13 trials conducted in LMHIC). Most interventions (18) were delivered via text messages alone, one was delivered through voice calls only, and the rest were delivered through combinations of different communication channels, such as multimedia messages and voice calls. Pregnant and postpartum women TCCMD versus standard care For behaviours, TCCMD may increase exclusive breastfeeding in settings where rates of exclusive breastfeeding are less common (risk ratio (RR) 1.30, 95% confidence intervals (CI) 1.06 to 1.59; low-certainty evidence), but have little or no effect in settings where almost all women breastfeed (low-certainty evidence). For use of health services, TCCMD may increase antenatal appointment attendance (odds ratio (OR) 1.54, 95% CI 0.80 to 2.96; low-certainty evidence); however, the CI encompasses both benefit and harm. The intervention may increase skilled attendants at birth in settings where a lack of skilled attendants at birth is common (though this differed by urban/rural residence), but may make no difference in settings where almost all women already have a skilled attendant at birth (OR 1.00, 95% CI 0.34 to 2.94; low-certainty evidence). There were uncertain effects on maternal and neonatal mortality and morbidity because the certainty of the evidence was assessed as very low. TCCMD versus non-digital TCC (e.g. pamphlets) TCCMD may have little or no effect on exclusive breastfeeding (RR 0.92, 95% CI 0.79 to 1.07; low-certainty evidence). TCCMD may reduce 'any maternal health problem' (RR 0.19, 95% CI 0.04 to 0.79) and 'any newborn health problem' (RR 0.52, 95% CI 0.25 to 1.06) reported up to 10 days postpartum (low-certainty evidence), though the CI for the latter includes benefit and harm. The effect on health service use is unknown due to a lack of studies. TCCMD versus digital non-targeted communication No studies reported behavioural, health, or well-being outcomes for this comparison. For use of health services, there are uncertain effects for the presence of a skilled attendant at birth due to very low-certainty evidence, and the intervention may make little or no difference to attendance for antenatal influenza vaccination (RR 1.05, 95% CI 0.71 to 1.58), though the CI encompasses both benefit and harm (low-certainty evidence). Pregnant and postpartum women living with HIV TCCMD versus standard care For behaviours, TCCMD may make little or no difference to maternal and infant adherence to antiretroviral (ARV) therapy (low-certainty evidence). For health service use, TCC mobile telephone reminders may increase use of antenatal care slightly (mean difference (MD) 1.5, 95% CI -0.36 to 3.36; low-certainty evidence). The effect on the proportion of births occurring in a health facility is uncertain due to very low-certainty evidence. For health and well-being outcomes, there was an uncertain intervention effect on neonatal death or stillbirth, and infant HIV due to very low-certainty evidence. No studies reported on maternal mortality or morbidity. TCCMD versus non-digital TCC The effect is unknown due to lack of studies reporting this comparison. TCCMD versus digital non-targeted communication TCCMD may increase infant ARV/prevention of mother-to-child transmission treatment adherence (RR 1.26, 95% CI 1.07 to 1.48; low-certainty evidence). The effect on other outcomes is unknown due to lack of studies. Parents of children aged less than five years No studies reported on correct treatment, nutritional, or health outcomes. TCCMD versus standard care Based on 10 trials, TCCMD may modestly increase health service use (vaccinations and HIV care) (RR 1.21, 95% CI 1.08 to 1.34; low-certainty evidence); however, the effect estimates varied widely between studies. TCCMD versus non-digital TCC TCCMD may increase attendance for vaccinations (RR 1.13, 95% CI 1.00 to 1.28; low-certainty evidence), and may make little or no difference to oral hygiene practices (low-certainty evidence). TCCMD versus digital non-targeted communication TCCMD may reduce attendance for vaccinations, but the CI encompasses both benefit and harm (RR 0.63, 95% CI 0.33 to 1.20; low-certainty evidence). No trials in any population reported data on unintended consequences. AUTHORS' CONCLUSIONS: The effect of TCCMD for most outcomes is uncertain. There may be improvements for some outcomes using targeted communication but these findings were of low certainty. High-quality, adequately powered trials and cost-effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCCMD. Future studies should measure potential unintended consequences, such as partner violence or breaches of confidentiality.


Assuntos
Telefone Celular , Saúde da Criança/normas , Comunicação , Necessidades e Demandas de Serviços de Saúde , Saúde do Lactente/normas , Saúde Materna/normas , Aleitamento Materno/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Parto Obstétrico/normas , Feminino , Infecções por HIV/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Saúde Materna/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Período Pós-Parto , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Envio de Mensagens de Texto
13.
Nutrients ; 12(8)2020 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-32731389

RESUMO

Reproductive health is a significant public health issue during pandemics; however, the impacts of the novel 2019 coronavirus disease (COVID-19) on noninfected pregnant women are still unknown. This study intends (1) to examine whether emotional eating (EE) occurred during the pandemic triggered by disease concerns and (2) to explore the associations among EE, dietary changes, and gestational weight gain (GWG). Based on an online survey, 640 new mothers who experienced the lockdown in their third trimester were recruited from seven provinces in China. EE was evaluated with the Chinese version of the Dutch Eating Behavior Questionnaire, EE domain. A self-designed e-questionnaire was used to collect the data of participants on the sociodemographic characteristics, concerns about the COVID-19 pandemic, maternity information, physical activities, and dietary changes during lockdown. The results show that the average EE score was 26.5 ± 8.3, and women living in a severely affected area, who are very worried about the pandemic and who had less physical activity had a higher tendency of EE. Although there is a dietary pattern changed during pandemic, the average GWG in the studied group was in the normal range. However, a higher EE score was associated with a significant excess of GWG in women not from Wuhan (EE score 33-65 vs. 13-22: adjusted Odd Ratio (OR), 95% Confidence Interval (CI) = 1.90, 1.08-3.32). The sensitivity analysis that additionally adjusted for the pregestational body mass index and gestational metabolic disease was consistent with this result. The mediation model was also examined and showed that, after adjusting for living area and exercise, EE was associated with significantly increased consumption of cereals (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 2.22, 1.29-3.82) and oil (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 3.03, 1.06-8.69) but decreased consumption of fish and seafood (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 1.88, 1.14-3.11; 23-32 vs. 13-22: adjusted OR, 95% CI = 1.79, 1.20-2.66). In conclusion, this study indicated that EE occurred in a proportional number of pregnant women during the COVID-19 pandemic and is associated with excess GWG mediated by increased intake of certain foods. The findings suggest the need for psychosocial and nutritional education and interventions during pregnancy checkups. Further studies are needed to determine modifiable psychosocial predictors and potential nutritional concerns in pregnant women during disease outbreaks.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Dieta , Comportamento Alimentar/psicologia , Ganho de Peso na Gestação , Pandemias , Pneumonia Viral/epidemiologia , Adulto , China/epidemiologia , Emoções , Feminino , Humanos , Saúde Materna/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição Materna/fisiologia , Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Inquéritos e Questionários
14.
Lancet Diabetes Endocrinol ; 8(9): 793-800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822601

RESUMO

Gestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research.


Assuntos
Saúde da Criança/tendências , Diabetes Gestacional/terapia , Saúde Materna/tendências , Criança , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Hiperglicemia/terapia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Gravidez
16.
Artigo em Inglês | PAHO-IRIS | ID: phr-52618

RESUMO

[ABSTRACT]. Objectives. To identify bottlenecks and barriers to effective coverage by Early Childhood Health and Development (ECHD) interventions in Guatemala. Methods. A scoping review of more than 100 peer-reviewed articles, grey literature, and other academic publications was conducted. Articles published from 2005-2019 were considered. Results were analyzed using the Tanahashi model of effective coverage that categorizes coverage by five domains: availability, accessibility, acceptability, contact, and effective coverage. Results. A total of 103 articles were identified, addressing 337 bottlenecks and barriers to effective coverage by ECHD interventions in Guatemala. Most occurred along the acceptability dimension (35.9%). The findings revealed four opportunity spaces: (i) strong political interest and commitment (opportunity for leadership); (ii) vibrant community health networks (opportunity for leverage); (iii) availability of promising evidence-based projects and interventions (opportunity for scale-up); and (iv) strong agency presence (opportunity for collaboration). Conclusions. Most bottlenecks and barriers to ECHD interventions in Guatemala occur around acceptability, followed by accessibility and availability. There is considerable potential for national leadership, leverage, scale-up, and collaboration of ongoing efforts in the country. These results may be used to inform future research and policymaking. The Tanahashi approach is an effective lens of analysis that can be applied to other countries, geographic areas, and contexts in future studies.


[RESUMEN]. Objetivos. Identificar los obstáculos y las barreras que impiden una cobertura efectiva de las intervenciones de salud y desarrollo en la primera infancia en Guatemala. Métodos. Se llevó a cabo una revisión sistemática exploratoria de más de 100 artículos revisados por pares, literatura gris y otras publicaciones académicas. Se consideraron artículos publicados entre 2005 y 2019. Los resultados se analizaron utilizando el modelo de Tanahashi de cobertura efectiva que clasifica la cobertura en cinco dominios: disponibilidad, accesibilidad, aceptabilidad, contacto y cobertura efectiva. Resultados. Se identificaron 103 artículos que abordan 337 obstáculos y barreras a la cobertura efectiva de las intervenciones de salud y desarrollo en la primera infancia en Guatemala. La mayoría de ellos se produjeron en la dimensión de la aceptabilidad (35,9%). Los resultados revelaron cuatro espacios de oportunidad para la acción: i) un fuerte interés y compromiso políticos (oportunidad de liderazgo); ii) redes de salud comunitarias dinámicas (oportunidad de apalancamiento); iii) disponibilidad de proyectos e intervenciones prometedores basados en la evidencia (oportunidad de ampliación); y iv) marcada presencia de instituciones (oportunidad de colaboración). Conclusiones. La mayoría de los obstáculos y las barreras a las intervenciones de salud y desarrollo en la primera infancia en Guatemala se dan en torno a la aceptabilidad, seguida de la accesibilidad y la disponibilidad. Existe un considerable potencial para el liderazgo nacional, el apalancamiento, la ampliación y la colaboración entre los emprendimientos en curso en el país. Estos resultados pueden utilizarse para fundamentar futuras investigaciones y la formulación de políticas. El enfoque de Tanahashi es una herramienta de análisis eficaz que puede aplicarse a otros países, zonas geográficas y contextos en estudios futuros.


Assuntos
Equidade em Saúde , Saúde Materna , Saúde da Criança , Países em Desenvolvimento , Guatemala , Equidade em Saúde , Saúde Materna , Saúde da Criança , Países em Desenvolvimento
17.
Enferm. foco (Brasília) ; 11(2): 68-75, jul. 2020. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1104082

RESUMO

Objetivo: Descrever a legislação trabalhista internacional vigente relacionada à saúde materna, bem como comparar seus efeitos sobre o binômio mãe e filho. Método: Estudo descritivo no qual foi utilizado método documental. Foram analisadas e categorizadas as legislações trabalhistas do Brasil, Canadá, França, Moçambique e Portugal. A pesquisa foi realizada mediante busca por documentos legais de domínio público, utilizando as legislações trabalhistas relacionadas à saúde reprodutiva, promoção da saúde e licença-maternidade, de âmbito nacional e internacional. Resultados: Percebeu-se que todos os países estudados oferecem licença maternidade, porém variam-se o período de tempo, a remuneração da mulher e os pré-requisitos que garantem o auxílio. O Canadá assiste melhor a mulher em seus direitos trabalhistas e Moçambique apresenta a menor cobertura de direitos trabalhistas. Conclusões: Concluiu-se que a licença maternidade que cada país oferece à mulher influencia diretamente no seu ciclo gravídico-puerperal e ao retorno da sua vida profissional. (AU)


Objective: To describe the current international labor legislation related to maternal health, as well as to compare its effects on the mother and child binomial. Method: Descriptive study in which documentary method was used. Five labor laws, available in Portuguese, English and French from the following countries were analyzed: Brazil, Canada, France, Mozambique and Portugal. The research was conducted by searching for public domain legal documents, using labor laws related to reproductive health, health promotion and maternity leave, nationally and internationally. Results: Two categories emerged: Comparison of maternity leave and Legal Rights in the construction of maternal and child health. It was noticed that all the countries studied offer maternity leave, but the time period, the woman's remuneration and the prerequisites that guarantee the aid vary. Canada best assists women in their labor rights and Mozambique has the lowest labor rights coverage. Conclusions: It was concluded that the maternity leave that each country offers women directly influences their pregnancy-puerperal cycle and the return of their professional life. (AU)


Objetivo: Describir la legislación laboral internacional actual relacionada con la salud materna, así como comparar sus efectos en el binomio madre e hijo. Método: estudio descriptivo en el que se utilizó el método documental. Se analizaron cinco leyes laborales, disponibles en portugués, inglés y francés de los siguientes países: Brasil, Canadá, Francia, Mozambique y Portugal. La investigación se realizó mediante la búsqueda de documentos legales de dominio público, utilizando leyes laborales relacionadas con la salud reproductiva, la promoción de la salud y la licencia de maternidad, a nivel nacional e internacional. Resultados: Surgieron dos categorías: Comparación de la licencia de maternidad y Los derechos legales en la construcción de la salud materna e infantil. Se observó que todos los países estudiados ofrecen licencia de maternidad, pero el período de tiempo, la remuneración de la mujer y los requisitos previos que garantizan la ayuda varían. Canadá ayuda mejor a las mujeres en sus derechos laborales y Mozambique tiene la cobertura de derechos laborales más baja. Conclusiones: se concluyó que el permiso de maternidad que cada país ofrece a las mujeres influye directamente en su ciclo embarazo-puerperal y en el retorno de su vida profesional. (AU)


Assuntos
Saúde Materna , Legislação Trabalhista , Enfermagem , Promoção da Saúde
19.
Matern Child Health J ; 24(9): 1093-1098, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32696248

RESUMO

The coronavirus 2019 (COVID-19) pandemic and related policies have led to an unequal distribution of morbidity and mortality in the U.S. For Black women and birthing people, endemic vulnerabilities and disparities may exacerbate deleterious COVID-19 impacts. Historical and ongoing macro-level policies and forces over time have induced disproportionately higher rates of maternal morbidity and mortality among Black women and birthing people, and contemporary macroeconomic and healthcare policies and factors continue to hold particular consequence. These factors induce detrimental psychological, health, and behavioral responses that contribute to maternal health disparities. The COVID-19 pandemic is likely to disproportionately impact Black women and birthing people, as policy responses have failed to account for the their unique socioeconomic and healthcare contexts. The resulting consequences may form a 'vicious cycle', with upstream impacts that exacerbate upstream macro-level policies and forces that can further perpetuate the clustering of maternal morbidity and mortality in this population. Understanding the impacts of COVID-19 among Black women and birthing people requires theoretical frameworks that can sufficiently conceptualize their multi-level, interacting, and dynamic nature. Thus, we advocate for the proliferation of syndemic perspectives to guide maternal disparities research and prevention during the COVID-19 pandemic. These perspectives can enable a holistic and nuanced understanding of the intersection of endemic and COVID-19-specific vulnerabilities and disparities experienced by Black women and birthing people. Syndemic-informed research can then lead to impactful multi-level prevention strategies that simultaneously tackle both endemic and COVID-19-specific factors and outcomes that lead to the clustering of vulnerabilities and disparities over time.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Coronavirus , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Afro-Americanos/estatística & dados numéricos , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Humanos , Saúde Materna , Mortalidade Materna , Morbidade , Pneumonia Viral/epidemiologia , Vigilância da População , Pesquisa , Fatores Socioeconômicos , Sindemia , Estados Unidos/epidemiologia
20.
Nutr Metab Cardiovasc Dis ; 30(9): 1520-1524, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32665208

RESUMO

BACKGROUND AND AIMS: Despite evidence that pregnancy planning improves outcomes, in Italy, as in many other countries worldwide, <50% of women with diabetes prepare their pregnancy. The aim of this study was to document training and knowledge on diabetes and pregnancy (D&P) among diabetes professionals. METHODS AND RESULTS: We administered an anonymous online questionnaire, focused on diabetes and pregnancy planning, to diabetes team members. Between Nov-2017 and Jul-2018, n = 395 professionals (60% diabetes/endocrinology/internal medicine specialists, 28% fellows) completed the survey. Fifty-nine percent of the specialists, mainly (78%) those completing their fellowship after 2006, reported having received training on D&P during fellowship. Considering specialists reporting training, 43% correctly identified fetal risks of inadequate preconceptional glucose control and 55% maternal risks, 38% identified risks associated with overweight/obesity, and 39% would prescribe hormonal contraception to women with diabetes only if glucose control is good. CONCLUSIONS: The results of our survey suggest the need to improve training and awareness of professionals in the area of diabetes and pregnancy.


Assuntos
Endocrinologistas/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Medicina Interna , Complicações na Gravidez/prevenção & controle , Gravidez em Diabéticas/terapia , Adulto , Anticoncepção , Educação de Pós-Graduação em Medicina , Endocrinologistas/educação , Serviços de Planejamento Familiar , Bolsas de Estudo , Feminino , Humanos , Medicina Interna/educação , Internato e Residência , Masculino , Saúde Materna , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Gravidez em Diabéticas/diagnóstico , Gravidez em Diabéticas/fisiopatologia , Gravidez não Planejada , Medição de Risco , Fatores de Risco , Especialização , Inquéritos e Questionários
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