Cândida Caniçali Primo

Baby-Friendly Hospital Initiative: evaluation of the Ten Steps to Successful Breastfeeding

Objective: To asses the performance of the Ten Steps to Successful Breastfeeding in an university hospital. Methods: Descriptive and quantitative research, in which 103 people were interviewed in the outpatient prenatal clinic, in the maternity-ward and in the Neonatal Intensive Care Unit of a university hospital in Vitoria, Southeast Brazil. The “Institutional Self-Evaluation Questionnaire” of the Baby Friendly Hospital Initiative was applied. Using this tool, the outcome was measured by the concordance index (CI) proposed by the World Health Organization and by the United Nations Children’s Fund. Results: Although the hospital does not have a policy that addresses promotion, protection and support for breastfeeding, 93.3% of the mothers had contact with their babies immediately after birth (step 4), 83.3% of the professionals guided mothers how to breastfeed (step 5), 86.6% of the neonates did not receive any food or drink other than breast milk (step 6), 100% of babies were housed together with their mothers (step 7), 83.3% of the women were encouraged for breastfeeding on demand (step 8) and 100% of the infants did not use bottles or pacifiers (step 9). Conclusions: 60% of the steps were completed by the hospital. The greatest difficulty was to inform pregnant women about the importance and the management of breastfeeding (step 3). Therefore, visits to pregnant women are recommended, in order to prepare them for breastfeeding and to explain about the infants’ healthy feeding habits.

The invasive behaviour of Cryptococcus neoformans : a possibility of direct access to the central nervous system?

Cryptococcocal meningoencephalitis is always considered secondary to initial lung infection. Because of the unquestionable evidence of haematogenious spread from the lungs, few publications have reported about other possible primary sites of infection or other routes to the central nervous system. This study was designed to investigate the infiltrative pattern of C. neoformans in immunocompromised mice by treatment with dexamethasone. The infection was performed by nasal instillation (30 mice) or injection into the retro-orbital space (12 mice). From the group infected intranasally, 3 mice presented diffuse invasive fungal colonisation of the mucosa and submucosa. The histologic findings showed infiltrative growth along the periosteum, sometimes surrounded nervous endings of submucosa, invasion along the olfactory nerve and simultaneous meningeal involvement in 2 mice on the 6th and 8th day of infection.All mice infected into the retro-ocular space developed lesions containing numerous cryptococci in the local of the inoculum. Out of the main lesion we observed preferential growth along the perineural spaces with adherence to the perineurium, perivascular spaces and sometimes along aponeurosis. Simultaneous invasion of trigeminal ganglio and trigeminal branches was observed in 4 mice. These morphologic patterns suggest the hypothesis of direct infiltrative invasion of the central nervous system.

Fatores de risco para mortalidade neonatal no município de Serra, Espírito Santo

Objetivou-se analisar os fatores de risco associados a mortalidade neonatal no municipio de Serra, ES. Realizou-se estudo de coorte nao concorrente, utilizando a tecnica de Linkage que pareou os 32.275 nascidos vivos com 273 obitos neonatais ocorridos no periodo de 2001 a 2005, utilizando-se dados do SINASC e SIM. Apos os ajustes na regressao logistica, os fatores associados a mortalidade foram: maes sem instrucao, idade materna 35 anos, nascer em hospital publico, nenhuma consulta de pre-natal, peso ao nascer.The objective was to analyze the risk factors associated with neonatal mortality in the city of Serra, ES. We studied non-concurrent cohort, using the technique of Linkage that relate the 32.275 live births with 273 neonatal deaths occurred in the period from 2001 to 2005, using data from SINASC and SIM. After adjustments in the logistic regression, factors associated with mortality were: uneducated mothers, maternal age <15 years and > 35 years old, born in a public hospital, no prenatal consultation, birth weight.

Uso da Classificação Internacional para as Práticas de Enfermagem na assistência a mulheres mastectomizadas

RESUMO Objetivo: Caracterizar o perfil de mulheres submetidas a mastectomia participantes de um Programa de Reabilitacao; identificar os diagnosticos de enfermagem mais comuns e elaborar as intervencoes para cada diagnostico, utilizando a Classificacao Internacional para as Praticas de Enfermagem - CIPE/versao1.0. Metodos: Estudo descritivo realizado em hospital de referencia para Oncologia em Vitoria – ES. A amostra abrangeu 239 prontuarios sorteados aleatoriamente e os dados, coletados em maio de 2008, focaram os registros das consultas de enfermagem as mulheres mastectomizadas. Resultados: Dentre as 239 participantes, 64,8% tinham entre 40 e 59 anos, 55%, eram casadas, 48,2% cursaram o ensino fundamental incompleto, 60,7% eram da regiao metropolitana do Estado do ES e 34,3% exerciam atividades do lar. Os diagnosticos registrados nao possuiam relacao exclusiva com o câncer de mama e podem ser verificados em clientes com outras alteracoes de saude. Conclusao: A CIPE utiliza metodos praticos para elaboracao do diagnostico e selecao das intervencoes que facilitam a sistematizacao da assistencia de enfermagem. Descritores: Diagnostico de enfermagem; Neoplasias mamarias; Processos de enfermagem; MastectomiaObjective: To characterize the profile of women that underwent mastectomy and participated in a rehabilitation program, to identify the most common nursing diagnoses and interventions for each diagnosis, using the International Classification for Nursing Practice (ICNP), version1.0. Methods: It was a descriptive study conducted in a referral hospital for Oncology in the city of Vitoria, ES. The sample consisted of 239 randomly selected records and the data was collected in May 2008; the research focused on the records of nursing visits to women with mastectomies. Results: Among the 239 participants, 64.8% were between 40 and 59 years, 55% were married, 48.2% finished the elementary school, 60.7% were from the metropolitan region of the ES state, and 34.3 % were housewives. The diagnoses recorded did not have exclusive relationship with breast cancer and may be found in clients with other health alterations. Conclusion: The ICNP uses practical methods for making the diagnosis and selection of interventions that facilitate the systematization of nursing care.

Efeitos do relaxamento na ansiedade e nos níveis de IgA salivar de puérperas

This experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espirito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearson’s correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety. DESCRIPTORS: postpartum depression; anxiety; relaxation techniques; immunoglobulin A; psychoneuroimmunology; pregnancy; postpartum periodThis experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espírito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearsons correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety.This experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espirito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearsons correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety.

Diagnósticos de enfermagem relacionados aos efeitos adversos da radioterapia

Radiotherapy is frequently used in cancer treatment, but it often causes several adverse effects, both immediate and late ones. Objective: To construct nursing diagnoses related to the adverse effects of radiotherapy. Methodology: This is a descriptive, exploratory study, consisting of three stages: literature review on the adverse effects of radiotherapy using textbooks on oncology, and fully available articles from Lilacs and Bdenf databases; selection of empirical indicators, and construction of the nursing diagnoses, according to the ICNP® 2011. Results: 97 diagnoses were constructed considering five different adverse effects (xerostomia, radiodermatitis, trismus, mucositis, and osteoradionecrosis). Conclusion: The previously elaborated diagnoses will be able to guide adequate interventions, allowing for individualized care, and contributing for the effective establishment of the nursing consultation at the Radiotherapy sector.Radiotherapy is frequently used in cancer treatment, but it often causes several adverse effects, both immediate and late ones. Objective: To construct nursing diagnoses related to the adverse effects of radiotherapy. Methodology: This is a descriptive, exploratory study, consisting of three stages: literature review on the adverse effects of radiotherapy using textbooks on oncology, and fully available articles from Lilacs and Bdenf databases; selection of empirical indicators, and construction of the nursing diagnoses, according to the ICNP® 2011. Results: 97 diagnoses were constructed considering five different adverse effects (xerostomia, radiodermatitis, trismus, mucositis, and osteoradionecrosis). Conclusion: The previously elaborated diagnoses will be able to guide adequate interventions, allowing for individualized care, and contributing for the effective establishment of the nursing consultation at the Radiotherapy sector.

Using the International Classification for Nursing Practice in the care of women with mastectomy

RESUMO Objetivo: Caracterizar o perfil de mulheres submetidas a mastectomia participantes de um Programa de Reabilitacao; identificar os diagnosticos de enfermagem mais comuns e elaborar as intervencoes para cada diagnostico, utilizando a Classificacao Internacional para as Praticas de Enfermagem - CIPE/versao1.0. Metodos: Estudo descritivo realizado em hospital de referencia para Oncologia em Vitoria – ES. A amostra abrangeu 239 prontuarios sorteados aleatoriamente e os dados, coletados em maio de 2008, focaram os registros das consultas de enfermagem as mulheres mastectomizadas. Resultados: Dentre as 239 participantes, 64,8% tinham entre 40 e 59 anos, 55%, eram casadas, 48,2% cursaram o ensino fundamental incompleto, 60,7% eram da regiao metropolitana do Estado do ES e 34,3% exerciam atividades do lar. Os diagnosticos registrados nao possuiam relacao exclusiva com o câncer de mama e podem ser verificados em clientes com outras alteracoes de saude. Conclusao: A CIPE utiliza metodos praticos para elaboracao do diagnostico e selecao das intervencoes que facilitam a sistematizacao da assistencia de enfermagem. Descritores: Diagnostico de enfermagem; Neoplasias mamarias; Processos de enfermagem; MastectomiaObjective: To characterize the profile of women that underwent mastectomy and participated in a rehabilitation program, to identify the most common nursing diagnoses and interventions for each diagnosis, using the International Classification for Nursing Practice (ICNP), version1.0. Methods: It was a descriptive study conducted in a referral hospital for Oncology in the city of Vitoria, ES. The sample consisted of 239 randomly selected records and the data was collected in May 2008; the research focused on the records of nursing visits to women with mastectomies. Results: Among the 239 participants, 64.8% were between 40 and 59 years, 55% were married, 48.2% finished the elementary school, 60.7% were from the metropolitan region of the ES state, and 34.3 % were housewives. The diagnoses recorded did not have exclusive relationship with breast cancer and may be found in clients with other health alterations. Conclusion: The ICNP uses practical methods for making the diagnosis and selection of interventions that facilitate the systematization of nursing care.

Effects of relaxation on anxiety and salivary IgA levels in puerperae

This experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espirito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearson’s correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety. DESCRIPTORS: postpartum depression; anxiety; relaxation techniques; immunoglobulin A; psychoneuroimmunology; pregnancy; postpartum periodThis experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espírito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearsons correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety.This experimental study aimed to evaluate the effect of relaxation techniques on anxiety levels, and the relation between anxiety and the concentration of Immunoglobulin A. The study was carried out in a maternity hospital in a city of the State of Espirito Santo, Brazil. The sample was composed of 60 puerperae. The information on the variables: age, education, marital status, type of childbirth, and parity were collected with a specific form; the trait and state of anxiety were based on the State Trait Anxiety Inventory (STAI/IDATE); and the level of salivary IgA was obtained through immunoturbidimetry. The application of the Mann-Whitney, Wilcoxon, and Pearsons correlation statistical tests showed a significant reduction in the levels of the state of anxiety in the experimental group (p = 0.01); there was no correlation between the trait and state variables of anxiety and the salivary IgA level; both groups (experimental and control) showed trait and state of medium-intensity anxiety.

Interactive Theory of Breastfeeding: creation and application of a middle-range theory

OBJECTIVE To describe a breastfeeding theory based on Kings Conceptual System. METHOD Theoretical study that used analysis of concept, assertion synthesis, and derivation of theory for the creation of a new theory. RESULTS Kings system components were associated with elements of the breastfeeding process and a middle-range theory was created, which describes, explains, predicts, and prescribes breastfeeding by analyzing factors that precede and affect it, as well as their consequences on the breastfeeding process. CONCLUSION The Breastfeeding Interactive Model is abstract enough to be applied in different social, cultural, political, and economic contexts, because it conceptualizes breastfeeding in systemic, dynamic, and procedural aspects. Based on a conceptual model of nursing, it contributes to the scientific construction of the subject; however it can also potentially be applied by other professionals involved in breastfeeding assistance.

Iniciativa Hospital Amigo da Criança: avaliação dos Dez Passos para o Sucesso do Aleitamento Materno

Objective: To asses the performance of the Ten Steps to Successful Breastfeeding in an university hospital. Methods: Descriptive and quantitative research, in which 103 people were interviewed in the outpatient prenatal clinic, in the maternity-ward and in the Neonatal Intensive Care Unit of a university hospital in Vitoria, Southeast Brazil. The “Institutional Self-Evaluation Questionnaire” of the Baby Friendly Hospital Initiative was applied. Using this tool, the outcome was measured by the concordance index (CI) proposed by the World Health Organization and by the United Nations Children’s Fund. Results: Although the hospital does not have a policy that addresses promotion, protection and support for breastfeeding, 93.3% of the mothers had contact with their babies immediately after birth (step 4), 83.3% of the professionals guided mothers how to breastfeed (step 5), 86.6% of the neonates did not receive any food or drink other than breast milk (step 6), 100% of babies were housed together with their mothers (step 7), 83.3% of the women were encouraged for breastfeeding on demand (step 8) and 100% of the infants did not use bottles or pacifiers (step 9). Conclusions: 60% of the steps were completed by the hospital. The greatest difficulty was to inform pregnant women about the importance and the management of breastfeeding (step 3). Therefore, visits to pregnant women are recommended, in order to prepare them for breastfeeding and to explain about the infants’ healthy feeding habits.