Relationship between geographic accessibility to emergency services and infant mortality: A systematic review and meta-analysis.

AIM: To evaluate the methodological quality of studies that analysed the relationship between accessibility to emergency services and infant mortality. METHODS: A systematic review with meta-analysis, registered on the international prospective register of systematic reviews (PROSPERO) platform under code CRD42021279854. Medline/Pubmed, Embase, SciElo, Lilacs, Scopus and web of science electronic databases were searched between November 2021 and May 2024, without language or publication time restriction. We included observational studies that compared the infant mortality outcome with the different distances travelled or travel time to health services in a paediatric emergency. Thus, we excluded studies with primary outcomes present in the pre- and perinatal periods, as well as distances or travel time to obstetric emergency units. We used the grade to assess the methodological quality of the studies and the Newcastle-Ottawa scale for the risk of bias, in addition to performing a meta-analysis. RESULTS: The evidence quality on infant mortality was moderate for four studies and low for three studies. The meta-analysis showed that children who travelled more than 5 km to the emergency service had a 28% increase in the chance of dying (P = 0.002), as well as those travelling for more than 40 min increased by 45% (P < 0.001). CONCLUSIONS: There was a relationship between the increase in geographic accessibility distance and travel time with the increase in infant mortality. However, the studies still showed moderate to low methodological quality.

Temporal trend in fetal mortality according to two death avoidability classifications.

OBJECTIVE: To analyze the temporal trend of fetal mortality and its components, of avoidable and ill-defined causes according to two avoidability classifications in Recife, Pernambuco, 2010-2021. METHOD: Ecological study of temporal trends of fetal mortality in Recife, 2010-2021. The Brazilian List of Avoidable Causes of Death for fetal deaths (LBE-OF) and Brazilian List of Avoidable Causes of Death for children under five years of age (LBE < 5) were used. The Joinpoint regression model was applied to analyze the temporal trends. RESULTS: Trends in fetal mortality and its components were stationary. The group of avoidable causes presented higher mortality rates in both classifications, with an increasing trend according to the LBE-OF (Annual Percentage Change-APC: 2,1; p = 0,018) and stationary according to the LBE < 5. There was a decreasing trend in mortality from ill-defined causes only according to the LBE-OF (APC: -12,3; p < 0,001). CONCLUSION: The results showed the stagnation of the temporal trend in fetal mortality, the avoidability of most deaths, and the potential of LBE-OF in monitoring the quality of information on the basic causes and avoidability of fetal deaths.

Effect of exercise-induced bronchospasm and parental beliefs on physical activity of asthmatic adolescents from a tropical region.

BACKGROUND: Physical activity (PA) is an essential health promotion factor. In asthmatic children and adolescents, exercise-induced bronchospasm (EIB) and parental beliefs and attitudes toward PA may be limiting issues. OBJECTIVE: To compare PA levels in asthmatic adolescents with and without EIB and the influence of mothers' beliefs of asthma worsening due to PA and attitudes in restraining their children's PA, asthma severity, severe EIB, or bronchospasm perception. METHODS: We performed a cross-sectional, hypothesis-testing study from December 1, 2008, through August 31, 2009, using the International Physical Activity Questionnaire to assesses PA levels in 134 asthmatic adolescents (10-19 years of age, 60% male) from an underprivileged community. EIB was defined as a decrease in forced expiratory volume in 1 second greater than 10% from basal 5, 15, or 30 minutes after treadmill running for 8 minutes. Subjective factors were evaluated through specific questionnaires. RESULTS: EIB was diagnosed in 46% of patients and was not associated with lower PA levels (odds ratio, 1.62; 95% confidence interval, 0.75-3.52). The other factors evaluated were also not associated with lower PA levels, although 78% of the mothers said they believe asthmatic children cannot participate in PA as much as nonasthmatic children, 44% that exercise can be harmful, and 52% that they restrained their children's PA. CONCLUSION: We found no association between EIB and low PA levels, although EIB was a frequent event that should be addressed by health care professionals, along with mother's beliefs and attitudes toward PA.

[Neonatal near miss in referral hospitals for high-risk pregnancy and childbirth: a cross-sectional study]. / Near miss neonatal em hospitais de referência para gestação e parto de alto risco: estudo transversal.

The article aimed to describe and compare indicators of neonatal near miss in referral hospitals for high-risk pregnancy and childbirth. This exploratory study was performed in two general hospitals in Recife, Pernambuco, Brazil. The study included cases of neonatal near miss in the year 2016 with gestational age < 33 weeks, birthweight < 1,750g, 5-minute Apgar < 7, or admission to the neonatal intensive care unit (ICU) and that remained alive at 7 days of life. Data were extracted from the Brazilian Information System on Live Births, Mortality Information System, Hospital Information System, and National Registry of Healthcare Establishments to characterize all live births at the institutions, cases of near miss, and availability of technology. Neonatal near miss and early neonatal mortality rates were calculated. The Pernambuco Maternal-Child Institute (IMIP) received the most serious cases and had the highest neonatal near miss rate (119.21 per thousand live births; p = 0.009) and early neonatal mortality rate (35.22 per thousand live births; p < 0.001). The University Hospital had the highest proportion of neonatal ICU admissions (76% of the near miss cases; p < 0.001). Neonatal near miss rates differed between the hospitals and are useful for surveillance of neonatal care in healthcare institutions, but they require attention to the local profile and context when the objective is to perform evaluations with classification. The findings reflect the complexity of assessing different health services.

O objetivo do artigo foi descrever e comparar indicadores de near miss neonatal em hospitais de referência para gestação e parto de alto risco. É um estudo exploratório, transversal, realizado em dois hospitais gerais localizados na cidade do Recife, Pernambuco, Brasil. Considerou-se casos de near miss neonatal os recém-nascidos do ano de 2016 com idade gestacional < 33 semanas ou peso ao nascer < 1.750g ou Apgar no 5º minuto de vida < 7 ou internação em unidade de terapia intensiva (UTI) neonatal, e que permaneceram vivos até 7 dias de vida. Os dados foram extraídos do Sistema de Informações sobre Nascidos Vivos e sobre Mortalidade, do Sistema de Informações Hospitalares e do Cadastro Nacional de Estabelecimentos de Saúde, para caracterizar todos os nascidos vivos das instituições, os casos de near miss e a disponibilidade de tecnologia. Calculou-se os indicadores de near miss neonatal e a taxa de mortalidade neonatal precoce. O Instituto de Medicina Integral Professor Fernando Figueira acolheu a clientela de maior gravidade, apresentou maior taxa de near miss neonatal (119,21 por mil nascidos vivos; p = 0,009) e de mortalidade neonatal precoce (35,22 por mil nascidos vivos; p < 0,001). O Hospital das Clínicas registrou a maior proporção de internações em UTI neonatal (76% dos casos; p < 0,001). Os indicadores de near miss neonatal demonstraram diferenças entre os hospitais analisados, sendo úteis para a vigilância da assistência neonatal em instituições de saúde, mas necessitam de atenção ao perfil e contexto local quando a intenção é realizar avaliações classificatórias. Os achados mostram a complexidade de avaliar diferentes serviços de saúde.

El objetivo del artículo fue describir y comparar indicadores de near miss neonatal en hospitales de referencia para el embarazo y parto de alto riesgo. Se trata de un estudio exploratorio, transversal, realizado en dos hospitales generales, localizados en la ciudad de Recife, Pernambuco, Brasil. Se consideraron casos de near miss neonatal a los recién nacidos del año 2016, con una edad gestacional < 33 semanas o peso al nacer < 1.750g o Apgar en el 5º minuto de vida < 7 o internamiento en la unidad de terapia intensiva (UTI) neonatal y que permanecieron vivos hasta los 7 días de vida. Los datos se extrajeron del Sistema de Información sobre Nacidos Vivos y sobre Mortalidad, del Sistema de Información Hospitalaria y Registro Nacional de Establecimientos de Salud para caracterizar a todos los nacidos vivos de las instituciones, los casos de near miss y la disponibilidad de tecnología. Se calcularon los indicadores de near miss neonatal y la tasa de mortalidad neonatal precoz. El Instituto de Medicina Integral Profesor Fernando Figueira acogió a pacientes de mayor gravedad, presentó una mayor tasa de near miss neonatal (119,21 por mil nacidos vivos; p = 0,009) y de mortalidad neonatal precoz (35,22 por mil nacidos vivos; p < 0,001). El Hospital de las Clínicas obtuvo mayor proporción de internamientos en UTI neonatal (76% de los casos de near miss; p < 0,001). Los indicadores de near miss neonatal demostraron diferencias entre los hospitales analizados, siendo útiles para la vigilancia de la asistencia neonatal en instituciones de salud, pero que necesitan atención respecto al perfil y contexto local, cuando la intención es realizar evaluaciones clasificatorias. Los resultados muestran la complejidad de evaluar diferentes servicios de salud.

EARLY NEONATAL NEAR MISS IN A UNIVERSITY HOSPITAL: COMPARATIVE CROSS-SECTIONAL STUDY.

OBJECTIVE: To compare 2012 and 2016 data on early neonatal near miss indicators from Health Information Systems at a university hospital. METHODS: This is a cross-sectional study conducted in 2012 and 2016. We considered early neonatal near misses the live births that presented one of the following risk conditions at birth: gestational age <33 weeks, birth weight <1,750g or 5-minute Apgar score <7, or Neonatal Intensive Care Unit (NICU) admission, and were alive until the 7th day of life. Data were collected from the Live Birth Information System, Hospital Information System, and Mortality Information System. We calculated the early neonatal mortality rate, neonatal near miss rate, severe neonatal outcome rate, early neonatal survival index, and early neonatal mortality index, compared by year of birth. RESULTS: In 2012, 304 early neonatal near misses were registered, with a higher proportion of cases with very low birth weight and mothers who had zero to three prenatal visits. In 2016, the number of cases was 243, with a predominance of more NICU admissions. The incidence of early neonatal deaths and early neonatal near misses was higher in 2012 than in 2016. CONCLUSIONS: Neonatal near miss indicators identified difference between years. The cases were more severe in 2012 and there were more NICU admissions in 2016.

Evaluation of the kangaroo method during the Covid-19 pandemic in two reference maternity hospitals in Pernambuco / Avaliação do método canguru durante pandemia de Covid-19 em duas maternidades de referência em Pernambuco

Abstract Objectives: to evaluate the second stage of the Kangaroo Mother Care (KMC) and its integration with the third stage in maternity hospitals in Recife in the context of the coronavirus pandemic. Methods: normative assessment carried out at the Kangaroo Neonatal Intermediate Care Unit (KNICU) in two public reference maternity hospitals for KMC between November/2021 and May/2022. The logical model and matrix of KMC indicators were developed and validated using the Delphi Method: semi-structured interviews were carried out with professionals from the KNICU team and the municipal child health coordination. It was considered implemented when the criteria were met (from 100.0 to 80.0%); partially implemented (79.9 to 60.0%); incipient (59.9 to 40.0%) and not implemented (<or=39.9%). Results: the MC was partially implemented in both KNICU (79.0% both). The Structure dimension was implemented (84.0 and 97.0%) and the Process dimension, in the Education (70.0% both) and Management components, were partially implemented (61.0% and 78.0%), although the units claim that they do not share clinical objectives, exams and treatments and do not have an effective referral/counter-referral system. While Assistance was implemented in one unit (90.0%) and partially implemented in the other (75.0%). Conclusion: KNICU was partially implemented during the coronavirus pandemic in the two reference maternity hospitals, but with obstacles to integration with the third stage of the method.

Resumo Objetivos: avaliar a segunda etapa do Método Canguru (MC) e a sua integração com a terceira etapa em maternidades do Recife no contexto da pandemia de coronavírus. Métodos: avaliação normativa realizada na Unidade de Cuidados Intermediários Neonatais Canguru (UCINCa) em duas maternidades públicas de referência para o MC entre novembro/2021 e maio/2022. Elaborou-se o modelo lógico e a matriz de indicadores do MC, validada através do Método Delphi. Realizaram-se entrevistas semiestruturadas com profissionais da equipe das UCINCa e a coordenação municipal de saúde da criança. Considerou-se implantado quando os critérios alcançaram (de 100,0 a 80,0%); parcialmente implantado (79,9 a 60,0%); incipiente (59,9 a 40,0%) e não implantado (<ou=39,9%). Resultados: o MC estava parcialmente implantado nas duas UCINCa (79,0% ambas). A dimensão Estrutura encontrava-se implantada (84,0 e 97,0%) e a de Processo, nos componentes Educação (70,0% ambas) e Gestão encontravam-se parcialmente implantados (61,0% e 78,0%), embora as unidades afirmem não compartilhar os objetivos clínicos, exames e tratamentos e não ter um sistema de referência/contrarreferência efetivo. Ao passo que o componente Assistencial estava implantado em uma unidade (90,0%) e parcialmente implantado na outra (75,0%). Conclusão: a UCINCa encontrava-se parcialmente implantada durante a pandemia de coronavírus nas duas maternidades de referências, mas com obstáculos para a integração com a terceira etapa do método.

NEONATAL MORBIDITY NEAR MISS IN TERTIARY HOSPITALS IN A CAPITAL OF NORTHEAST BRAZIL.

OBJECTIVE: To characterize near miss neonatal morbidity in tertiary hospitals in a capital city of Northeast Brazil based on Health Information Systems, and to identify differences regarding indicators of near miss cases, allowing the surveillance of newborns with risk of death. METHODS: A cross-sectional study carried out in hospitals with neonatal intensive care unit, whose neonatal near miss cases in 2012 were identified from a deterministic linkage between the Mortality Information System and the Live Birth Information System. The biological variables of children, variables related to maternal characteristics and indicators of near miss were calculated by type of service and hospital. Biological variables of children, variables related to maternal characteristics and near miss indicators were calculated by service type and hospital and then compared by ratio difference test, parametric and non-parametric tests for measures of central tendency. RESULTS: Of 24,254 live births, 2,098 cases of neonatal morbidity near miss were identified, most of them concentrated in the public hospitals (89.9%). The combination of birth weight and gestational age had the largest number of cases in both segments, public (43.5%) and private (46%). Variations in neonatal near miss indicators were observed between hospitals, which suggests assistance problems. CONCLUSIONS: The concept of neonatal near miss, its applicability with data from Health Information Systems, and its indicators are a preliminary tool to monitor hospital care for newborns by signaling health services that require in-depth evaluation and investments for quality improvement.

Assessment of Motor Skills in Children With Visual Impairment: A Systematic and Integrative Review.

This study aimed to review and examine the tools used to assess psychomotor performance of children with visual impairment. Databases, such as SCOPUS, MEDLINE/PubMed, Medline/EBSCO, Web of Science, LILACS, CINAHL, and ScienceDirect, were searched using Mesh terms. Data from manuscripts fully available in these databases between 1994 and 2017 (except CINAHL-2014) concerning the evaluation, tool development, or intervention for the improvement of motor skills in children (age, 7-10 years) with visual impairment were collected. The Critical Review Form-Quantitative Studies was used to evaluate the quality of the articles. As a result, 1113 articles were found, but only 24 met the inclusion criteria; 66.7% of the articles had moderate quality, with unsatisfactory results regarding the validity and reliability of the tools used to assess these children, as well as the absence of clinical importance and practical application in such studies. Only the Test of Gross Motor Development-2 and Movement Assessment Battery for Children-2 described data on the validation and reliability in visually impaired children. To minimize systematic errors and improve the quality of the investigations, increasing the number of studies regarding the tools, functionality of their activities, and testing the adaptions is necessary.

PHYSICAL ACTIVITY LEVEL IN ASTHMATIC ADOLESCENTS: CROSS-SECTIONAL POPULATION-BASED STUDY.

OBJECTIVE: To assess the level of physical activity in asthmatics in comparison with non-asthmatics in a population study. METHODS: Cross-sectional study with 13 to 14-year-old adolescents who participated in the International Study of Asthma and Allergies in Childhood (ISAAC). The subjects were classified into three groups: individuals with active asthma, individuals diagnosed with asthma, and respiratory asymptomatic individuals. To evaluate the level of physical activity, the International Physical Activity Questionnaire (IPAQ-short version) was used. The analysis consisted of comparing individuals with active asthma, diagnosed as asthmatic and asymptomatic, with a significance level of 5%. RESULTS: The participants were 1,591 adolescents, of which 791 (49.7%) were male. There were 222 (14.0%) individuals with active asthma and 284 (17.8%) asthma diagnoses; 55% of the population were physically active. Adolescents diagnosed with asthma were more active than their non-asthmatic peers (64.4 versus 53.3%; p=0.001). CONCLUSIONS: Adolescents diagnosed with asthma were more physically active than their non-asthmatic peers.

Ensino de pediatria e puericultura no curso médico: cenários de prática em discussão / Teaching pediatrics and child care in medical courses: discussing practical scenarios

RESUMO Introdução: A integralidade da atenção à saúde da criança constitui diretriz para o ensino de pediatria, sendo essenciais as atividades práticas em todos níveis de atenção do Sistema Único de Saúde. Objetivo: Este estudo teve como objetivo descrever carga horária, cenários de práticas e preceptoria utilizados no ensino da saúde da criança e do adolescente. Método: Trata-se de um estudo transversal, com aplicação de questionário constituído por 43 questões objetivas e duas questões abertas, encaminhado por meio de formulário eletrônico para 247 escolas médicas do país que contavam com pelo menos uma turma formada em 2019. Resultado: Responderam ao questionário 37 (14,97%) escolas médicas, sendo 16 públicas e 21 privadas de 14 estados da Federação e das cinco regiões. Verificou-se mediana de 940,5 horas direcionadas à saúde da criança e do adolescente, equivalente a 11% da carga horária total dos cursos; 13 escolas apresentaram inserção de temas de saúde da criança desde o primeiro ano, e a maioria (75,8%), a partir do terceiro ano. Atividades práticas predominaram no internato: 87,5% (quinto ano) e 88,8% (sexto ano). Os cenários incluíram unidades básicas de saúde, comunidade, ambulatórios de pediatria geral e especializados, unidades de internação, serviços de neonatologia, urgência e emergência e laboratórios de habilidades e simulação. Foi referido que o ensino de puericultura é desenvolvido em ambulatórios de pediatria geral (32 escolas) e em unidades básicas de saúde dos municípios (32 escolas), estas consideradas essenciais para formação. Docentes pediatras desenvolvem preceptoria na maioria dos cenários de práticas; pediatras da instituição de ensino ou do sistema local de saúde estão mais presentes em unidades de internação (70,3% e 54,0%, respectivamente) e ambulatórios especializados (54,0% e 35,1%, respectivamente). Conclusão: Com participação de 37 escolas médicas, este estudo apresenta limitações para generalizações sobre o ensino no país. Neste estudo observou-se que o ensino sobre saúde da criança e do adolescente desenvolve-se em todos níveis de atenção à saúde, visando à integralidade, sendo destinados em média 11% da carga horária total do curso para esse ensino. Houve predominância de docentes e médicos pediatras na preceptoria, e a puericultura permaneceu como componente relevante na atenção básica, sendo apontados desafios para manutenção desse cenário de práticas.

ABSTRACT Introduction: Comprehensive child health care is a guideline in pediatric teaching, and it is essential to develop practical activities considering all levels of health care in the Unified Health System. Objectives: To describe the hours involved, practice scenarios and preceptorship in pediatric and childcare teaching in medical schools. Method: A cross-sectional study using a questionnaire with 43 objectives and two open questions, sent by electronic forms to medical schools across the country that had already graduated at least one class in 2019. Results: 37 (14.97%) medical schools with at least one graduated class answered the questionnaire (16 public and 21 private schools) from 14 states in the five regions of the country. A median of 940.5 hours was found for the teaching of pediatrics, equivalent to 11% of the total medical course; 13 schools included child health topics since the first year and the majority (75.8%) from the third year onwards. Practical activities predominated in the internship: 87.5% (5th year) and 88.8% (6th year). The used settings include primary health care, general and specialty pediatric outpatient clinics, inpatient units, neonatology units, emergency services and simulation laboratories. It was reported that childcare teaching is carried out in general pediatric outpatient clinics (32 schools) and basic community health units (32 schools), with an emphasis on primary care as the essential setting for teaching childcare. Pediatric teachers provide preceptorship in all practice settings; non-teaching pediatricians from the medical institution or the local health system are more present in inpatient units (70.3% and 54.0%, respectively) and specialty outpatient clinics (54.0% and 35.1%, respectively). Conclusions: With the participation of 37 medical schools, this study has limitations for the generalizations about teaching in the country. Pediatric teaching is carried out in practice environments at all levels of care, demonstrating the importance of comprehensive child and adolescent health care, with an average of 11% of the course total workload allocated to this teaching. The predominant participation of pediatricians as teachers was observed. The learning of childcare has remained a relevant component of pediatric training and its development is significant in primary care, although there are challenges to preserving this practice setting.

Temporal trend in fetal mortality according to two death avoidability classifications / Tendencia temporal de la mortalidad fetal según dos clasificaciones de muerte evitable / Tendência temporal da mortalidade fetal segundo duas classificações de evitabilidade do óbito

ABSTRACT Objective: To analyze the temporal trend of fetal mortality and its components, of avoidable and ill-defined causes according to two avoidability classifications in Recife, Pernambuco, 2010-2021. Method: Ecological study of temporal trends of fetal mortality in Recife, 2010-2021. The Brazilian List of Avoidable Causes of Death for fetal deaths (LBE-OF) and Brazilian List of Avoidable Causes of Death for children under five years of age (LBE < 5) were used. The Joinpoint regression model was applied to analyze the temporal trends. Results: Trends in fetal mortality and its components were stationary. The group of avoidable causes presented higher mortality rates in both classifications, with an increasing trend according to the LBE-OF (Annual Percentage Change-APC: 2,1; p = 0,018) and stationary according to the LBE < 5. There was a decreasing trend in mortality from ill-defined causes only according to the LBE-OF (APC: -12,3; p < 0,001). Conclusion: The results showed the stagnation of the temporal trend in fetal mortality, the avoidability of most deaths, and the potential of LBE-OF in monitoring the quality of information on the basic causes and avoidability of fetal deaths.

RESUMEN Objetivo: Analizar la tendencia temporal de la mortalidad fetal y sus componentes, causas evitables y mal definidas según dos clasificaciones de evitabilidad en Recife, Pernambuco, 2010-2021. Metodología: Estudio ecológico de tendencias temporales de la mortalidad fetal en Recife, 2010-2021. Se utilizó la Lista Brasileña de Causas Evitables de Muerte para muertes fetales (LBE-OF) y la Lista Brasileña de Causas Evitables de Muerte para niños menores de cinco años (LBE < 5). Se aplicó el modelo de regresión Joinpoint para analizar las tendencias temporales. Resultados: Las tendencias en la mortalidad fetal y sus componentes se mantuvieron estacionarias. El grupo de causas evitables presentó mayores tasas de mortalidad en ambas clasificaciones, con tendencia creciente según LBE-OF (Variación Porcentual Anual-APC: 2,1; p = 0,018) y estacionaria según LBE < 5. Hubo tendencia decreciente para la mortalidad por causas mal definidas sólo según LBE-OF (APC: -12,3; p < 0,001). Conclusión: Los resultados mostraron el estancamiento de la tendencia temporal de la mortalidad fetal, la evitabilidad de la mayoría de las muertes y el potencial del LBE-OF para monitorear la calidad de la información sobre las causas básicas y la evitabilidad de las muertes fetales.

RESUMO Objetivo: Analisar a tendência temporal da mortalidade fetal e de seus componentes, das causas evitáveis e mal definidas segundo duas classificações de evitabilidade no Recife, Pernambuco, 2010-2021. Método: Estudo ecológico de tendência temporal para a mortalidade fetal no Recife, 2010-2021. Foram utilizadas as classificações de evitabilidade Lista Brasileira de Causas de Morte Evitáveis para óbitos fetais (LBE-OF) e Lista Brasileira de Causas de Morte Evitáveis para menores de cinco anos (LBE < 5). O modelo de regressão Joinpoint foi aplicado para analisar as tendências temporais. Resultados: As tendências da mortalidade fetal e de seus componentes foram estacionárias. O grupo de causas evitáveis apresentou maiores taxas de mortalidade nas duas classificações, com tendência crescente segundo a LBE-OF (Variação Percentual Anual-APC: 2,1; p = 0,018) e estacionária segundo a LBE < 5. Houve tendência decrescente para a mortalidade por causas mal definidas apenas conforme a LBE-OF (APC: -12,3; p < 0,001). Conclusão: Os resultados evidenciaram a estagnação da tendência temporal da mortalidade fetal, a evitabilidade da maior parte dos óbitos, e a potencialidade da LBE-OF no monitoramento da qualidade das informações sobre as causas básicas e evitabilidade dos óbitos fetais.

Construção e validação de indicadores para avaliação da implantação do método canguru utilizando técnica Delphi / Construction and validation of indicators to evaluate the implementation of the kangaroo method using the Delphi technique

Objetivo: Apresentar o processo de validação de uma matriz de indicadores para avaliação da implantação da segunda e terceira etapas do Método Canguru (MC) em duas maternidades de referência e na atenção básica em Recife. Métodos: O processo de construção e validação seguiu quatro passos: (1) elaboração do modelo lógico da segunda e terceira etapas do MC; (2) composição da matriz de indicadores preliminar; (3) seleção de especialistas, envio de indicadores a esse grupo para análise utilizando a Técnica Delphi; (4) consolidação dos resultados e envio aos especialistas para segunda consulta e análise final. Adotou-se um Índice de Validade de Conteúdo (IVC) igual ou superior a 80% para estabelecer a concordância. Resultados: O modelo lógico foi composto de componentes para segunda e terceira etapas do MC, com os subcomponentes Educação e Assistencial, e um componente para a interface das duas etapas, com o subcomponente Gestão. Dos 110 itens apresentados, dois não apresentaram consenso na primeira rodada e três sugestões de alteração foram feitas. Cinco novos indicadores foram incluídos, totalizando ao final 113 indicadores. Conclusão: O uso da técnica Delphi possibilitou ampliar o consenso e validar a matriz de indicadores do MC na perspectiva de especialistas envolvidos com a estratégia. Descritores: Método Canguru; Avaliação de Programas e Instrumentos de Pesquisa; Técnica Delfos; Pesquisa sobre Serviços de Saúde; Estudo de Validação.

Objective: To present the validation process of a matrix of indicators to evaluate the implementation of the second and third stages of the Kangaroo Method (KM) in two reference maternity hospitals and in primary care in Recife.Methods: The construction and validation process followed four stages: (1) elaboration of the logical model of the 2nd and 3rd stage of the KM; (2) composition of the preliminary indicator matrix; (3) selection of experts, sending indicators to this group for analysis using the Delphi Technique; (4) consolidation of results and sending to experts for second consultation and final analysis. A Content Validity Index (CVI) equal to or greater than 80% was adopted to establish agreement. Results: The logical model was composed of components for the 2nd and 3rd stages of the KM, with the Education and Care subcomponents, and a component for the interface of the two stages, with the Management subcomponent. Of the 110 items presented, two did not present consensus in the first round and three suggestions for changeswere made. Five new indicators were included, totaling 113 indicators at the end. Conclusion: The use of the Delhi technique made it possible to expand the consensus and validate the KM indicator matrix from the perspective of experts involved with the strategy. Descriptors: Kangaroo Method; Evaluation of Research Programs and Instruments; Delphi Technique; Research on Health Services. Validation Study.

Comunicação de más notícias em unidade de terapia intensiva neonatal / Breaking bad news in neonatal intensive care units / Comunicación de malas noticias en la unidad de cuidados intensivos neonatales

Resumo O protocolo Spikes é um dos instrumentos mais didáticos para o ensino da habilidade de comunicar más notícias, que exige sensibilidade e preparo. Neste artigo foram analisadas as percepções de residentes de pediatria, bem como de mães de neonatos, sobre a comunicação de más notícias em uma unidade de terapia intensiva neonatal. Trata-se de estudo qualitativo, descritivo e exploratório, baseado na antropologia visual, no qual o protocolo Spikes foi empregado em dois grupos focais, com abordagem analítica de conteúdo de Bardin por categorias. Foram relatados problemas como ambiente inadequado para comunicar más notícias, limitações na percepção das mães, falta de disponibilidade médica para conversar, linguagem inadequada e dificuldade para lidar com emoções, esclarecer dúvidas e discutir estratégias com os familiares. A reflexões sobre essas questões visa melhorar o aprendizado teórico e estimular a autocrítica, buscando a empatia e a humanização da assistência.

Abstract The SPIKES protocol is one of the most didactic tools to teach the communication of bad news, a skill that requires sensitivity and preparation. This article analyzed the perceptions of pediatrics residents and the mothers of neonates about the communication of bad news in a neonatal intensive care unit. This is a qualitative, descriptive and exploratory study, based on visual anthropology, in which the SPIKES protocol was used in two focus groups, with Bardin's content analytics approach by categories. Problems were reported as inadequate environment to break bad news, limitations in the perception of mothers, lack of medical availability to talk, inadequate language and difficulty to deal with emotions, clarify doubts and discuss strategies with family members. Reflection on these issues aims to improve theoretical learning and stimulate self-criticism, seeking empathy and the humanization of care.

Resumen El protocolo SPIKES es uno de los instrumentos más didácticos para enseñar la capacidad de comunicar malas noticias, lo que requiere sensibilidad y preparación. Este estudio analizó las percepciones de los residentes de pediatría y de las madres de recién nacidos sobre la comunicación de malas noticias en una unidad de cuidados intensivos neonatales. Se trata de un estudio cualitativo, descriptivo y exploratorio, basado en la antropología visual, en que se utilizó el protocolo SPIKES en dos grupos focales para categorizar el enfoque analítico del contenido. Se reportaron problemas como ambiente inadecuado para comunicar malas noticias, limitaciones en la percepción de las madres, falta de disponibilidad médica para hablar, lenguaje inadecuado y dificultad para lidiar con las emociones, aclarar dudas y discutir estrategias con los miembros de la familia. Las reflexiones sobre estos temas pretenden mejorar el aprendizaje teórico y estimular la autocrítica, buscando una atención más empática y humanizada.

Vídeo educativo participativo para humanização da assistência em saúde / Participatory educational video for the humanization of health care

Comunicar más notícias envolve, além de conhecimentos, complexidades afetivas e éticas. Sensibilizar médicos utilizando um vídeo participativo sobre a comunicação de más notícias em Unidade de Terapia Intensiva Neonatal, fundamentado no SPIKES e na antropologia visual. Qualitativa, descritiva exploratória, em três etapas: 1) Diagnóstico-participação de médicos e mães; 2) Desenvolvimento-produção do vídeo; e 3) Avaliação-percepção de médicos sobre o vídeo. Foi utilizada análise de conteúdo de Bardin.A Etapa 1 indicou: ambiência inadequada, pouca preocupação com as mães, pouco suporte emocional, inadequado convite para o diálogo, linguagem e comunicação inadequadas, pouca empatia e necessidade de melhorar a humanização. Sobre o vídeo baseado na Etapa 1, a percepção dos médicos indicou: aumento do seu grau de responsabilidade, reflexão sobre suas práticas profissionais e estímulo ao aprendizado teórico e à empatia nas relações profissionais na Unidade de Terapia Intensiva. Há dificuldades no processo de comunicação de más notícias, e a utilização de vídeo educativo participativo representa importante estratégia de incentivo à humanização da assistência em saúde.

Delivering bad news involves not only knowledge, but also affective and ethical difficulties.To raise the awareness of physicians using a participatory video about delivering bad news in an Intensive Care Therapy, based on SPIKES and on visual anthropology. Qualitative, descriptive, and exploratory study in three stages: 1) Diagnosis - participation of physicians and mothers; 2) Development - video production; 3) Evaluation - perception from physicians about the video. Bardin's content analysis was used;Stage 1 showed: inadequate environment, little concern about the mothers, little emotional support, inadequate openness for dialog, inadequate language and communication, little empathy, and need to improve humanization. About the video based on Stage 1, the perception of physicians indicated: increased degree of responsibility, reflections on their professional practices, and encouragement to theoretical knowledge and to empathy in professional relations in the Intensive Care Unit. There are issues in the process of delivering bad news, and the use of educational participatory videos is an important strategy to humanize health care.

[Early neonatal near miss identified through health information systems]. / Near miss neonatal precoce identificado com base em sistemas de informação em saúde.

The aim of this study was to validate a definition to identify cases of early neonatal near miss using data from health information systems (SIS in Portuguese). This was a concurrent validation study focusing on three definitions for identification of cases of early neonatal near miss among live births in a university hospital in 2012. Three different definitions were applied to this live birth cohort using the criteria birth weight, gestational age, 5-minute Apgar score, admission to the neonatal intensive care unit, mechanical ventilation, and congenital malformations, in different combinations, considering the proposals in two Brazilian articles (Silva et al.; Pillegi-Castro et al.) and a third (SIS definition) with available data from health information systems. Cases were defined as infants that had survived the risk conditions as of the 7th day of life. For concurrent validation, the study adopted early neonatal deaths as the reference. Of the 2,097 live births studied, 33 died in the early neonatal period, and the number of cases of early neonatal near miss varied according to the definition used: 153 (Silva definition), 194 (Pileggi-Castro definition), and 304 (SIS definition). Sensitivity and specificity were 97% and 92.6%, respectively, according to the Silva definition, 90.9% and 90.6% according to the Pileggi-Castro definition, and 93.9% and 85.3% according to the SIS definition. The results show that the SIS definition has sensitivity and specificity close to the other definitions and suggest that it is possible to monitor early neonatal near miss using only data that are available in official health information systems.

O objetivo foi validar uma definição de identificação de casos de near miss neonatal precoce utilizando dados dos sistemas de informação em saúde (SIS). Estudo de validação concorrente entre três definições para identificação de casos de near miss neonatal precoce, realizado em hospital universitário com nascidos vivos ocorridos em 2012. Foram aplicadas três definições a esta coorte de nascidos vivos com utilização dos critérios peso ao nascer, idade gestacional, Índice de Apgar no 5º minuto de vida, internação em Unidade de Terapia Intensiva neonatal, ventilação mecânica e más-formações congênitas com diferentes combinações, considerando as proposições de dois artigos brasileiros publicados (definição Silva et al.; definição Pillegi-Castro et al.) e uma terceira (definição SIS) com dados disponíveis em Sistemas de Informação em Saúde. Foram considerados casos os sobreviventes às condições de risco até o 7º dia de vida. Para a validação concorrente, adotaram-se como referência os óbitos neonatais precoces. Dos 2.097 nascidos vivos estudados, 33 foram a óbito no período neonatal precoce, e o número de casos de near miss neonatal precoce variou segundo a definição adotada: 153 (definição Silva), 194 (definição Pileggi-Castro) e 304 (definição SIS). A sensibilidade e especificidade foi, respectivamente, 97% e 92,6% na definição Silva, 90,9% e 90,6% na definição Pileggi-Castro e 93,9% e 85,3% na definição SIS. Os resultados mostram que a definição SIS apresenta sensibilidade e especificidade próxima às outras definições e sugere que é possível monitorar o near miss neonatal precoce com uso apenas de dados disponíveis nos sistemas oficiais de informações em saúde.

El objetivo fue validar una definición de identificación de casos de near miss neonatales precoces, utilizando datos de los sistemas de información en salud (SIS). Se trata de un estudio de validación concurrente entre tres definiciones para la identificación de casos de near miss neonatales precoces, realizado en un hospital universitario, con nacidos vivos que se produjeron en 2012. Se aplicaron tres definiciones a esta cohorte de nacidos vivos con la utilización de los criterios: peso al nacer, edad gestacional, índice de Apgar en el 5º minuto de vida, internamiento en la Unidad de Terapia Intensiva Neonatal, ventilación mecánica, además de malformaciones congénitas con diferentes combinaciones, considerando las propuestas de dos artículos brasileños publicados (definición Silva et al.; definición Pillegi-Castro et al.) y una tercera (definición SIS) con datos disponibles en el Sistema de Información en Salud. Se consideraron casos los supervivientes en condiciones de riesgo hasta el 7º día de vida. Para la validación concurrente, se adoptaron como referencia los óbitos neonatales precoces. De los 2.097 nacidos vivos estudiados, 33 fueron óbito durante el período neonatal precoz, y el número de casos de near miss neonatal precoz varió según la definición adoptada: 153 (definición Silva), 194 (definición Pileggi-Castro) y 304 (definición SIS). La sensibilidad y especificidad fue, respectivamente, 97% y 92,6% en la definición Silva, 90,9% y 90,6% en la definición Pileggi-Castro y 93,9% y 85,3% en la definición SIS. Los resultados muestran que la definición SIS presenta sensibilidad y especificidad próxima a las otras definiciones y sugiere que es posible monitorear el near miss neonatal precoz sólo con el uso de datos disponibles en los Sistemas oficiales de Información en Salud.

[Risk factors for perinatal mortality in Recife, Pernambuco State, Brazil, 2003]. / Fatores de risco para a mortalidade perinatal no Recife, Pernambuco, Brasil, 2003.

The aim of this study was to identify and analyze risk factors for perinatal mortality in Recife, Pernambuco State, Brazil, in 2003, using a multilevel hierarchical model. In this case-control study, cases consisted of all perinatal deaths in 2003 in singleton infants with birth weight > 500g and without congenital malformations. The controls were live births from December 26, 2002, to December 31, 2003, with the same characteristics as the study group, but who survived > 6 days. By using record linkage techniques, 403 cases and 1,612 controls were obtained. All variables, when submitted jointly to multiple logistic regression, showed statistical significance in decreasing order of risk, as follows: prematurity (OR = 18.23), low birth weight (OR = 4.90), maternal age > 35 (OR = 1.97), delivery in public hospitals (OR = 1.93), and maternal schooling < 4 years (OR = 1.78).

[Quality of data on early neonatal deaths]. / Qualidade dos dados sobre óbitos neonatais precoces.

OBJECTIVE: To investigate the quality of official neonatal death data in Maceió, Alagoas. METHOD: A descriptive study was conducted on early neonatal deaths in hospitals between January 1, 2001, and December 31, 2002, to compare data entry in the Death Certificate (DC) and Mortality Information System (MIS) with a standardized form filled out with data of medical files from the mothers and newborn. The frequency with which the following variables failed to be recorded in the DC and SIM was studied: type of death, address, age of mother, gender, birth weight, and delivery type, age at death and gestational age. MIS reliability was verified using simple concordance, sensitivity and Kappa indicator. RESULTS: MIS recorded 451 deaths, of which 50 were excluded. Mother's age was omitted from MIS in 44.1% of cases. 85.7% to 100% of the variables not filled in for the DC were recovered from the medical files. There was good concordance between DC and medical files for type of delivery, weight and age. Birth weight and age of mother presented the least concordance between medical files and MIS. MIS presented 69.2% sensitivity for weight and 36.3% for age of mother, thus demonstrating little capability to correctly supply information to generate perinatal health indicators. CONCLUSION: Because of incomplete filling out, quality of the DC becomes precarious and makes the MIS inadequate, even though it covers 100% of neonatal deaths in Maceió. Inefficiency of the system is increased by failure of MIS technicians to correct errors found and input all the information available.

Adaptation of the MABC-2 Test (Age Band 2) for children with low vision.

BACKGROUND: The tools used to assess motor performance in children with low vision often have no validity and reliability data concerning this population and use non-standardized modifications. Adaptations of these tools could help to identify motor problems and mitigate their effects. AIM: To assess aspects of validity and reliability in an adaptation of the Movement ABC-2 Test (MABC-2) for children with low vision. METHODS AND PROCEDURES: The research was undertaken in two stages: 1) application of the original MABC-2 to 10 children with low vision, adaptation and pilot test; 2) administration and re-administration of the adapted MABC-2 in 30 children with low vision. Inter-rater reliability and test-retest reliability were assessed with an intraclass correlation coefficient and Kappa index; internal consistency was assessed with Cronbach's alpha. OUTCOMES AND RESULTS: Substantial to almost perfect inter-rater reliability was found between the component standard scores and a reasonable to excellent concordance rate in the classification of movement difficulty. The adapted tool has moderate internal consistency. CONCLUSIONS AND IMPLICATIONS: The adapted MABC-2 Test has improved the assessment of motor performance in children with low vision.

Lower prevalence and greater severity of asthma in hot and dry climate.

OBJECTIVE: To estimate asthma prevalence, severity, and associated factors in adolescents who live in a low relative humidity environment. METHODS: In this cross-sectional study, adolescents aged 13-14 years from the city of Petrolina located in the Brazilian semiarid region answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The possible explanatory variables of the study were gender, family income, mother's education, smokers in the household, parental history of asthma, personal history of allergic rhinitis or atopic dermatitis, and physical activity level. Poisson regression analysis was used to assess the association between asthma and the explanatory variables. RESULTS: A total of 1591 adolescents participated in the study, of whom 49.7% were male. The prevalence of active asthma, severe asthma, and physician-diagnosed asthma were 14.0%, 10.4%, and 17.8%, respectively. Adolescents with asthma missed more school days than their peers (33 vs. 22 days/year; p<0.03). Associated factors that remained significant after adjustment were history of asthma in parents (PR=2.65, p<0.001) and personal diagnosis of allergic rhinitis (PR=1.96, p<0.001) and/or atopic dermatitis (PR=2.18, p<0.001). CONCLUSION: Asthma prevalence in this low-humidity environment was lower, but more severe than those reported in other Brazilian cities. The dry climate might hamper disease control and this may have contributed to the higher school absenteeism observed. The association of asthma with allergic rhinitis and atopic dermatitis as well as a history of asthma in parents suggests that atopy is an important risk factor for asthma in this population.

Exercise-induced bronchospasm in a hot and dry region: study of asthmatic, rhinitistic and asymptomatic adolescents.

BACKGROUND: Exercise-induced bronchospasm (EIB) is the bronchial narrowing that occurs after intense exercise in a significant number of asthmatics and in some non-asthmatics. This study aims to evaluate the occurrence of EIB in adolescents with asthma, rhinitis and respiratory asymptomatics in a hot and dry climate. RESEARCH DESIGN AND METHODS: This is a cross-sectional study based on an epidemiological study that evaluated the prevalence of asthma in schoolchildren in a semi-arid zone of Brazil. The EIB was defined as a reduction in forced expiratory volume in first second (FEV1) greater than 10%. RESULTS: A total of 114 individuals participated in the study (36.8% male), of whom 54 were asymptomatic, 30 asthmatic and 30 with rhinitis. Asthmatics presented a higher proportion of EIB in comparison to rhinitis and asymptomatics (46.7% vs. 13.3% and 7.4%, p = 0.001) and none of the individuals had severe EIB (ΔFEV1 ≥ 50%). CONCLUSIONS: A large proportion of the asthmatics selected from the community for the clinical study had EIB. Among participants with rhinitis, EIB was found in slightly more than 10%, while in the asymptomatics the frequency was slightly more than 5%. This study presents an important aspect in individuals living in hot and dry climates.