Carmen Viana Ramos

Alegações maternas para o desmame: estudo qualitativo

OBJECTIVE: To study the reasons for weaning given by women receiving care at a Baby-Friendly Maternity in Teresina, state of Piaui, Brazil. METHODS: The methodological principles of qualitative research were applied, supported by the social representation theory. Data were collected from 24 women who were in the process of weaning their babies before the 4th month of life. RESULTS: The decision-making process that leads women to wean their babies is complex and guilt-ridden. The following reasons for weaning were mentioned: having weak or little milk; puerperal problems affecting the breasts; lack of experience; disparity between the needs of the mother and the needs of the baby; external factors; work; ambiguity between wish/capacity to breastfeed and between burden/desire. CONCLUSIONS: A sense of solitude/isolation on the part of the mother and the need for support, not only from health services, but also from other segments of society, were conveyed in all interviews. The model of health care providing should be amended so as to treat breastfeeding as an act to be learned by women and protected by society.

Aleitamento materno: como é vivenciado por mulheres assistidas em uma unidade de saúde de referência na atenção materno-infantil em Teresina, Piauí

OBJETIVOS: ampliar a compreensao acerca de como as mulheres que desmamaram os seus filhos antes do quarto mes de vida percebem a amamentacao e a assistencia recebida no curso do ciclo gravidico-puerperal. METODOS: adotou-se a Teoria das Representacoes Sociais como referencial teorico-metodologico. Ao todo foram entrevistadas 24 mulheres com base num questionario semi-estruturado. A analise dos dados se deu a partir do metodo de analise de conteudo. RESULTADOS: a analise do discurso das entrevistadas permitiu evidenciar um verdadeiro descompasso entre o discurso proferido pela instituicao, em favor da amamentacao exclusiva ate o sexto mes de vida, e a vivencia das mulheres com relacao a este ato, que se traduziu na impossibilidade de cumprir tal orientacao frente as suas condicoes concretas de vida. CONCLUSOES: os resultados revelaram a necessidade de uma urgente reformulacao nos referenciais que embasam as acoes de saude voltadas para essa area, com vistas a contemplar, alem dos determinantes biologicos, os condicionantes socioculturais que permeiam a amamentacao.

Diagnóstico da situação do aleitamento materno no Estado do Piauí, Brasil

This study aims to evaluate the situation with breastfeeding in the State of Piauí, Brazil, at the time of the 2006 vaccination campaign. The sample consisted of 1,963 infants (< 1 year of age) from 45 municipalities. Medians and probabilities of breastfeeding categories were calculated by probit analysis. Multivariate logistic analysis was used to analyze the association between independent variables and partial and exclusive breastfeeding. The probabilities were: 16% for exclusive breastfeeding and 18% for predominant breastfeeding at 180 days of age and 58% for breastfeeding at 361 days. Median duration was 67 days for exclusive breastfeeding and 200 days for breastfeeding. The breastfeeding rate was higher for children whose mothers belonged to social classes C, D, and E (p = 0.024) and lived in the countryside (p = 0.009). Not nursing during the first 24 hours of life, using a pacifier, and bottle-feeding reduced the prevalence of breastfeeding (p < 0.001). The prevalence rates are below the recommended standards and reflect the need to prioritize actions to promote breastfeeding in the State.

A iniciativa hospital amigo da criança sob a ótica dos atores sociais que a vivenciam em Teresina, Piauí

OBJETIVO: Analisar os reflexos da Iniciativa Hospital Amigo da Crianca nos atores sociais que a vivenciam. METODOS: Estudo qualitativo. Utilizaram-se entrevistas semiestruturadas, com auxilio de um roteiro tematico, junto a vinte mulheres e dez profissionais de saude em cinco hospitais amigos da crianca em Teresina (PI). Para a analise dos dados foi utilizada a tecnica de analise de conteudo do tipo tematica. RESULTADOS: A analise das falas levou a construcao de dois eixos de discussao: um relacionado a triade de sustentacao da Iniciativa - promocao, protecao e apoio; e o outro a seu proprio modus operandi, os quais permitiram evidenciar dificuldades na implementacao das normas e rotinas da Iniciativa Hospital Amigo da Crianca desenvolvidas nas instituicoes. CONCLUSAO: Os resultados revelaram a necessidade de ajustes para melhorar a resolutividade do programa, com enfase para: adocao de uma nova matriz ensino-aprendizagem pautada na educacao reflexiva e na adocao dos referenciais da pedagogia da problematizacao; fortalecimento das redes de apoio a mulher; investimentos na melhoria do acolhimento, tornando a relacao cliente-profissional mais respeitosa e definicao de um processo de monitoramento continuo que permita a adocao de medidas corretivas sempre que se fizer necessario.

Prevalência do Aleitamento Materno Exclusivo e os fatores a ele associados em crianças nascidas nos Hospitais Amigos da Criança de Teresina - Piauí

This study assessed the factors associated with exclusive breastfeeding in public hospitals in Teresina, State of Piaui, Brazil. A total of 1,102 infants were surveyed. Probit analysis was used to calculate the probabilities of breastfeeding. The bivariate logistic regression model was used in order to analyze the association between variables. The probabilities found were: 19% for Exclusive Breastfeeding (EBF) and 16% for Predominant Breastfeeding (PBF) at 180 days; and 56% for Breastfeeding (BF) at 361 days. The median was 98 days for EBF and over 365 days for BF. There were differences between EBF medians and probabilities in the hospitals surveyed. The prevalence of EBF was higher among infants who were born in Hospital 3, who did not use baby bottles and were breastfed during the first 24 hours of life (p<0.05). Results show a better breastfeeding profile if compared to other studies, although below recommendations, reflecting the need for strategies to improve indexes.

Clinical and epidemiological aspects of microcephaly in the state of Piauí, northeastern Brazil, 2015–2016

OBJECTIVES To describe aspects of the microcephaly epidemic in the state of Piauí. METHODS All cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n=100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n=63) were used as a comparison group. RESULTS In October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p<0.001); 33 confirmed cases (35.9%) had a head circumference z-score between -2 and -3, 23 (25%) between -3 and -4, and 8 (8.7%) had a z-score of less than -4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group. CONCLUSIONS The state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.

Training of Professionals from the Family Health Strategy for Psychosocial Care for the Elderly

Background: Mental disorders of the elderly constitute a public health problem due to their high prevalence, shortage of specialized services offered in Brazil, difficulties of access by the population and deficiency in the training of professionals of the Family Health Strategy for the identification, receptiveness and psychosocial assistance to the elderly. Objectives: To analyze the training of professionals of the Family Health Strategy on psychosocial care for the elderly in the context of the Psychosocial Care Network – RAPS (Rede de Atencao Psicossocial), and to discuss how professional training influences the care provided to the elderly. Methodology: Descriptive, qualitative study carried out with 31 professionals, 13 physicians and 18 nurses, who work at the Family Health Strategy of the city of Picos, Piaui, Brazil. The data were collected in January 2016, through a semi-structured interview guide, processed by the IRAMUTEQ software and analyzed by means of the Descending Hierarchical Classification. Results: The results were presented in three segments, namely: 1. The practice of professionals from the Family Health Strategy in psychosocial care in the family context; 2. Training of specialized professionals, in the attention to the elderly, in the Family Health Strategy; 3. The Psychosocial Attention Network in the care of elderly users of alcohol and other drugs; Conclusion: Health professionals have difficulties in dealing with the elderly with mental disorders in basic care. In order to facilitate access to specialized health services and to develop actions for social reintegration, prevention and harm reduction, it is necessary to implement a policy of ongoing training and education for health professionals to improve care for the elderly. Keywords: Aging; Mental Health; Mental disorders; Family Health Strategy.

Social Representations of Community Infection by Nurses of the Family Health Strategy

Background: Community infection that is detected or incubating on admission act, since not related to a previous admission in the same hospital. These infections constitute a public health problem by the risk that people are exposed in the community. The evaluation of the risk of infection is a complex process involving clinical, psychosocial, and environmental data. Aim: Apprehend the social representations of community infection by nurses of the Family Health Strategy. Methods: Exploratory qualitative study, conducted from February to March of 2016 in 18 basic health units of the Family Health Strategy (FHS), the Northern Regional Directorate, the city of Teresina, Piaui, Brazil, with 23 nurses. Data were collected through semi-structured interview, processed by software IRAMUTEQ and analyzed by descending hierarchical classification. Results: The results were presented in two axes: Axis 1-The nurse in the prevention of infection in the Community Health Strategy, with the classes: Class 3-Measures to prevent infection Community; Class 4-Health education for the prevention of community infection; Class 5-Nurse Interventions for preventing infection Community; Axis 2 - Extrinsic factors and social determinants related to community infection, with the classes: Class 2-The concept of community infection; Class 1-Types of community-acquired infections; Class 6-Risk factors for community-acquired infection. Conclusion: The knowledge developed and shared by the nurses of the Family Health Strategy on Community infection, rooted in the course of their professional practice, shows that the concept of community infection was not well built by professionals, referring only to unrelated infections to hospital.

Food guidance for diabetics in the family health strategy

Objective: analyzing the nutritional guidance received by diabetics in the Family Health Strategy. Method: an exploratory, descriptive study with a qualitative approach conducted with 16 type 2 diabetics who underwent assistance with the teams of the Family Health Strategy in the municipality of Piaui/PI. The data were produced through individual interviews, processed in IRAMUTEQ software and analyzed by Hierarchical Classification Descending. The project was approved by the Research Ethics Committee, CAAE 15720913.1.0000.5210. Results: there were identified six semantic classes: food guidance to the diabetic in the Family Health Strategy, the diagnosis of diabetes, the community health worker as a central element in the monitoring carried out for diabetics, food guidance conducted by nutritionist, assistance provided by the Health Strategy Family and drug treatment for diabetic patients in the Family Health Strategy. Conclusion: the nutritional guidance was held in a restrictive and prescriptive way, contrary to the current guidelines, as well as a greater appreciation of the drug in treatment by patients. Descriptors: Nutrition; Diabetes Mellitus; Health; Power Supply. RESUMO Objetivo: analisar a orientação alimentar recebida pelos diabéticos no âmbito da estratégia saúde da família. Método: estudo exploratório, descritivo, com abordagem qualitativa realizado com 16 diabéticos do tipo 2 que realizavam acompanhamento junto a equipes da Estratégia Saúde da Família em município do Piauí/PI. Os dados foram produzidos por meio de entrevistas individuais, processados no software IRAMUTEQ e analisados pela Classificação Hierárquica Descendente. O projeto teve a aprovação pelo Comitê de Ética em Pesquisa, CAAE 15720913.1.0000.5210. Resultados: identificaram-se seis classes semânticas: Orientação alimentar ao diabético na Estratégia Saúde da Família, O diagnóstico do diabetes, O agente comunitário de saúde como elemento central no acompanhamento realizado aos diabéticos, Orientação alimentar realizada pelo nutricionista, Assistência prestada pela Estratégia Saúde da Família e Tratamento medicamentoso ao diabético na Estratégia Saúde da Família. Conclusão: a orientação alimentar foi de realizada de forma restritiva e impositiva, em desacordo com as diretrizes atuais, além de uma maior valorização do medicamento no tratamento, por parte dos pacientes. Descritores: Nutrição; Diabetes Mellitus; Saúde; Alimentação. RESUMEN Objetivo: analizar la orientación nutricional recibida por los diabéticos en la Estrategia Salud de la Familia. Método: un estudio exploratorio, descriptivo, con un enfoque cualitativo realizado con 16 diabéticos tipo 2 que se sometieron a seguimiento con los equipos de la Estrategia Salud de la Familia en el municipio de Piauí/PI. Los datos se produjeron a través de entrevistas individuales, procesados en el software IRAMUTEQ y analizados por Clasificación Jerárquica Descendente. El proyecto fue aprobado por el Comité de Ética en la Investigación, CAAE 15720913.1.0000.5210. Resultados: se identificaron seis clases semánticas: orientación acerca de la alimentación al diabético en la Estrategia Salud de la Familia, el diagnóstico de la diabetes, el trabajador de salud de la comunidad como un elemento central en la supervisión llevada a cabo para los diabéticos, orientación de alimentos realizada por la nutricionista de la Estrategia Salud de la Familia y el tratamiento farmacológico para los pacientes diabéticos en la Estrategia Salud de la Familia. Conclusión: la orientación nutricional se llevó a cabo de manera restrictiva y prescriptiva, en contra de las directrices actuales, así como una mayor apreciación de la droga en el tratamiento por los pacientes. Descriptores: Nutrición; Diabetes Mellitus; Salud; Alimentación. Nutritionist, Master’s Student, Professional Mastership in Family Health, University Center UNINOVAFAPI. Teresina (PI), Brazil. Email: mary.margareth@hotmail.com; Nutritionist, Professor of Child and Women’s Health from the Fernandes Figueira Institute/Oswaldo Cruz Foundation, Masters Program Professor in Family Health of the University Center UNINOVAFAPI. Teresina (PI), Brazil. Email: cvramos@uninovapi.edu.br; Nurse, Professor Post-Doc of Nursing, Graduation in Nursing/Nursing Mastership Program, Federal University of Piaui/UFPI, Coordinator of the Professional Master’s Program in Family Health, University Center UNINOVAFAPI. Teresina (PI), Brazil. Email: mestradosaudedafamília@uninovafapi.edu.br; Nurse, Doctorate in Nursing, Coordinator of the Nursing Graduate Program, Federal University of Piaui/UFPI. Teresina (PI), Brazil. Email: benevina@ufpi.edu.br; Nutritionist, Professor in Biological Sciences, Department of Biophysics and Physiology, Mastership Program in Food and Nutrition, Federal University of Piaui, Mastership Program in Family Health, University Center UNINOVAFAPI. Teresina (PI), Brazil. Email: mcmartins@uninovafapi.edu.br ORIGINAL ARTICLE Fé MMM, Ramos CV, Moura ME et al. Food guidance for diabetics in the family...