Challenges in the care of children born to mothers diagnosed with COVID-19 during the pandemic.

OBJECTIVE: To understand the challenges in the care of children born to mothers with COVID-19 during the pandemic. METHOD: Qualitative research, conducted from November 2020 to May 2021, in two public maternity hospitals, with women who had children during the first wave of the pandemic, diagnosed with COVID-19 during pregnancy and/or childbirth. There were nineteen semi-structured interviews with thematic analysis. Symbolic Interactionism was used as a theoretical framework. RESULTS: Changes in the care for newborn children were identified. In the domestic environment, hygiene measures with the newborn children were intensified, social isolation restricted the support network and mothers felt alone and overwhelmed. In terms of health care, there was a setback in neonatal care and interruption of professional care, such as the suspension of appointments. CONCLUSION: The pandemic has restructured traditional models of family care, intensified difficulties in accessing healthcare, and exposed children to inherent risks due to a lack of proper follow-up.

Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth.

The COVID-19 pandemic has impacted public and private health systems around the world, impairing good practices in women's health care. However, little is known about the experiences, knowledge, and feelings of Brazilian women in this period. The objective was to analyze the experiences of women, seen at maternity hospitals accredited by the Brazilian Unified Health System (SUS, acronym in Portuguese), regarding health care during pregnancy, childbirth, and postpartum periods, their interpersonal relationships, and perceptions and feelings about the pandemic. This was a qualitative, exploratory research, carried out in three Brazilian municipalities with women hospitalized in 2020, during pregnancy, childbirth, or postpartum period, with COVID-19 or not. For data collection, semi-structured individual interviews (in person, by telephone, or by digital platform) were conducted, recorded and transcribed. The content analysis of thematic modalities was displayed as per the following axes: i) Knowledge about the disease; ii) Search for health care in prenatal, childbirth, and postpartum periods; iii) Experience of suffering from COVID-19; iv) Income and work; and v) Family dynamics and social support network. A total of 46 women were interviewed in São Luís-MA, Pelotas-RS, and Niterói-RJ. Use of media was important to convey information and fight fake news. The pandemic negatively impacted access to health care in the prenatal, childbirth, and postpartum periods, contributing to worsening of the population's social and economic vulnerabilities. Women experienced diverse manifestations of the disease, and psychic disorders were very frequent. Social isolation during the pandemic disrupted the support network of these women, who found social support strategies in communication technologies. Women-centered care-including qualified listening and mental health support-can reduce the severity of COVID-19 cases in pregnant, parturient, and postpartum women. Sustainable employment and income maintenance policies are essential to mitigate social vulnerabilities and reduce risks for these women.

Maternal health during the COVID-19 pandemic: Experiences of health workers in three Brazilian municipalities.

OBJECTIVE: To analyze the experiences of maternal health workers in three Brazilian cities, located in the Northeast (São Luís), Southeast (Niterói), and South (Pelotas) regions during the first year of the COVID-19 pandemic. METHODS: Qualitative research carried out between December 2020 and February 2021. Interviews were conducted, in person or remotely, with 30 health workers, doctors and nurses, working in maternity hospitals of different degrees of complexity. RESULTS: Sociodemographic characteristics, employment relationships and professional qualification of the interviewees were described. Two thematic axes were identified: 1) changes in hospital organization and dynamics in the pandemic; 2) Illness and suffering of health workers. The majority of respondents were women. Most physicians had work relationships in the public and private sectors. In Niterói, health workers had better professional qualifications and more precarious work relationships (as temporary hires), compared to São Luís and Pelotas. In the context of the uncertainties resulting from the pandemic, this situation generated even more insecurity for those workers. The statements at the beginning of the pandemic covered topics such as changes in the organizational dynamics of services, healthcare, telemedicine, and interaction between health workers and users. In the health workers' perception, the initial period of the health emergency, which resulted in intense changes in the provision of services, was marked by an increase in preterm births, perinatal mortality, and fetal losses. Work overload, fear of contamination, concern for family members and uncertainties regarding the new disease caused intense suffering in health workers who had little institutional support in the cities studied. The suffering experienced by health workers went beyond the work dimension, reaching their private life. CONCLUSION: Changes caused by the pandemic required immediate adjustments in professional practices, generating insecurities in healthcare regardless of the location studied. The method of hiring health workers remained the same as the previously practiced one in each city. Due to the risk of disease transmission, measures contrary to humanization practices, and more restrictive in São Luís, were reported as harmful to obstetric care. The Covid-19 pandemic was a huge challenge for the Brazilian health system, aggravating the working conditions experienced by health workers. In addition to the work environment, it was possible to briefly glimpse its effects on private life.

Challenges in the care of children born to mothers diagnosed with COVID-19 during the pandemic / Desafíos en la atención de niños nacidos de madres diagnosticadas con COVID-19 durante la pandemia / Desafios no cuidado de crianças nascidas de mães com diagnóstico de COVID-19 durante a pandemia

ABSTRACT Objective: To understand the challenges in the care of children born to mothers with COVID-19 during the pandemic. Method: Qualitative research, conducted from November 2020 to May 2021, in two public maternity hospitals, with women who had children during the first wave of the pandemic, diagnosed with COVID-19 during pregnancy and/or childbirth. There were nineteen semi-structured interviews with thematic analysis. Symbolic Interactionism was used as a theoretical framework. Results: Changes in the care for newborn children were identified. In the domestic environment, hygiene measures with the newborn children were intensified, social isolation restricted the support network and mothers felt alone and overwhelmed. In terms of health care, there was a setback in neonatal care and interruption of professional care, such as the suspension of appointments. Conclusion: The pandemic has restructured traditional models of family care, intensified difficulties in accessing healthcare, and exposed children to inherent risks due to a lack of proper follow-up.

RESUMEN Objetivo: Comprender los desafíos en el cuidado de niños nacidos de madres con COVID-19 durante una pandemia. Método: Investigación cualitativa, realizada de noviembre de 2020 a mayo de 2021, en dos maternidades públicas, con mujeres que tuvieron hijos durante la primera ola de la pandemia, diagnosticadas con COVID-19 durante el embarazo y/o parto. Se realizaron diecinueve entrevistas semiestructuradas con análisis temático. Se utilizó como marco teórico el Interaccionismo Simbólico. Resultados: Se identificaron cambios en el cuidado del recién nacido. En el ámbito doméstico, se redoblaron las medidas de higiene con el recién nacido, el aislamiento social restringió la red de apoyo y las madres se sintieron solas y abrumadas. En cuanto a la atención, hubo retroceso en la atención neonatal e interrupción de la atención profesional, como la suspensión de citas. Conclusión: La pandemia ha reestructurado los modelos tradicionales de cuidado familiar, intensificado las dificultades de acceso a la salud y expuesto a los niños a los riesgos inherentes a la falta de seguimiento.

RESUMO Objetivo: Compreender os desafios no cuidado de crianças nascidas de mães com COVID-19 durante a pandemia. Método: Pesquisa qualitativa, realizada de novembro de 2020 a maio de 2021, em duas maternidades públicas, com mulheres que tiveram filhos na primeira onda da pandemia, diagnosticadas com COVID-19, durante a gestação e/ou parto. Realizaram-se 19 entrevistas semiestruturadas com análise temática. Utilizou-se do Interacionismo Simbólico como referencial teórico. Resultados: Identificaram-se mudanças nos cuidados a crianças recém-nascidas. No ambiente doméstico, as medidas de higiene com o recém-nascido foram redobradas, o isolamento social restringiu a rede de apoio e as mães se sentiram sozinhas e sobrecarregadas. No âmbito assistencial, houve retrocesso no cuidado neonatal e interrupção de cuidados profissionais, como suspensão de consultas. Conclusão: A pandemia reestruturou os modelos tradicionais de cuidados familiares, intensificou as dificuldades de acesso à saúde e expôs as crianças a riscos inerentes à falta de acompanhamento.

Efeitos da pioglitazona em mulheres com obesidade e síndrome dos ovários policísticos / Pioglitazone effects in women with obesity and polycystic ovary syndrome

Introdução. A resistência à insulina é considerada a principal causa da síndrome dos ovários policísticos. A pioglitazona, droga sensibilizadora da insulina, da família das tiazolidinedionas, pode ser boa opção na abordagem medicamentosa da resistência à insulina em pacientes com a síndrome. Objetivo. Avaliar o efeito da pioglitazona em mulheres portadoras da doença sobre parâmetros clínicos e laboratoriais e a resistência à insulina. Métodos. Foram avaliadas nove mulheres com sobrepeso ou obesas, com a síndrome e resistência à insulina (HOMA-IR > 2,7), tratadas com 30 mg/dia de pioglitazona, durante três meses, em relação a critérios clínicos (freqüência dos ciclos menstruais, hiperandrogenismo, acantosis nigricans, relação cintura-quadris e índice de massa corporal) e laboratoriais (glicemia e insulina de jejum, teste de tolerância à glicose oral (TTGO) com dosagem de insulina, FSH, LH, estradiol, TSH, prolactina, TGO, TGP, gama-GT, fosfatase alcalina, uréia, creatinina e testosterona total. Resultados. As pacientes tratadas apresentaram regularização dos ciclos menstruais, melhoraram da acantosis nigricans e aumento não significativo do peso corporal, índice de massa corporal, circunferência do abdome e dos quadris e relação cintura-quadris. Os níveis séricos de glicose e insulina diminuíram significativamente em todos os tempos do teste de tolerância, bem como o HOMA-IR (p < 0,05), mas não o HOMA-b. As gonadotrofinas, os esteróides sexuais e a prolactina não tiveram modificações significativas, mas o TSH teve elevação significativa. TGO, TGP, γ-GT e fosfatase alcalina tiveram teor significativamente diminuído, mas a uréia ficou elevada sem alterar os níveis de creatinina. Conclusão. A pioglitazona tem efeitos favoráveis em parâmetros clínicos e laboratoriais relacionados à resistência à insulina em pacientes com a doença, e é boa alternativa no tratamento dessas pacientes.

Introduction. Insulin resistance is considered the main cause in the pathogenesis of the polycystic ovary syndrome. Pioglitazone, an insulin sensitizer drug of the thiazolidinediones family, may be a good alternative in the medical approach of these patients. Objective. To evaluate the pioglitazone’s effects in women with the syndrome on clinical and laboratorial parameters and insulin resistance. Methods. We evaluate nine obese or overweight women with this ovary disorder, with insulin resistance (HOMAIR > 2.7), treated with 30 mg/day of pioglitazone in relation clinical parameters (menstrual cycles frequency, hyperandrogenism, acantosis nigricans, waist-hip ratio and body mass index) and fast glucose, fast insulin, oral glucose tolerance test with insulin dosages, FSH, LH, estradiol, TSH, prolactin, OGT, PGT, γ-GT, alkaline phosphatase, urea, creatinine, total testosterone. Results. The patients had menstrual cycles regularization, acantosis nigricans improvement, and a no significant increase in weight, body mass index, waist and hip circumference and waist-hip ratio. Serum insulin and glucose levels significantly decreased in all times of the glucose tolerance test, as well as HOMA-IR (p < 0,05), but not HOMA-b. Gonadotropins, sexual steroids and prolactin did not have significant modifications, but TSH significantly increased. OGT, PGT, γ-GT and alkaline phosphatase levels decreased significantly, but urea increase without change creatinine level. Emotional memory modulation. Conclusion. Pioglitazone has favorable effects on clinical parameters and insulin resistance in patients with polycystic ovary syndrome, and it is a good alternative to treatment of these patients.