Ikaro Daniel de Carvalho Barreto

Aleitamento materno e aspectos fonoaudiológicos: conhecimento e aceitação de mães de uma maternidade

Purpose To investigate the knowledge of mothers about breastfeeding and aspects of Speech-Language Pathology; to compare mothers from a Kangaroo unit to others in a Rooming-in, considering time of admission; and to verify the acceptance in the intervened group.Methods Interventionist and comparative study with 163 mothers from a public maternity. The mothers were divided into two groups (G1 and G2) according to their type of allocation (Kangaroo Unit and Rooming-in). It was done an assertiveness test and guidelines with the mothers, focusing on breastfeeding, language, orofacial motricity/ speech and hearing aspects. Based on such aspects, guidelines were made and the acceptance test applied. In order to characterize the affirmatives and compare the knowledge between the groups, it was applied the Birnbaums Three-Parameter Unidimensional Model, based on the Item Response Theory, and Mann-Whitney U Test for the estimated knowledge, with p 85%.Results Concerning the assertiveness test, the highest percentage of correct answers was achieved by language (G1=98%; G2=95%), followed by orofacial motricity/ speech (G1=45%; G2=39%) and audition (G1=36%; G2=30%). There were no statistical significant relationship between hospitalization time and knowledge. 97% accepted the guidelines.Conclusion This health guidelines activity provided access to information, independently of time or type of hospitalization of the nursing mothers. The intervention good acceptance allows inferring about the viability of expand such practices in the hospital environment.

Fetal and neonatal deaths of children of patients classified as near miss

Objective: identify the epidemiological aspects of early fetal and neonatal deaths in children of patients classified with near miss and the factors associated with this outcome. Method: a cross-sectional study of 79 women identified with near miss and their newborns. The variables were analyzed using Fishers exact test. Risk factors were estimated based on unadjusted and adjusted odds ratios, and by means of multiple correspondence analysis, with significance for p <0.05. Results: hypertensive disorders totaled 40.5%; Of these, 58.3% had adverse fetal and neonatal outcome. The newborns admitted to the Neonatal Intensive Care Unit proved to be significant for the outcome (70.8%), gestational age <32 weeks (41.6%), birth weight <2500 (66.7%), neonatal asphyxia (50%) and early respiratory discomfort (72.2%). Conclusion: prematurity, neonatal asphyxia, and early respiratory distress were significant characteristics for the outcome among newborns.Objetivo: identificar os aspectos epidemiologicos dos obitos fetais e neonatais precoces em filhos de pacientes classificadas com near miss e os fatores associados a este desfecho. Metodo: estudo transversal realizado com 79 mulheres identificadas com near miss e seus recem-nascidos. As variaveis foram analisadas utilizando-se o teste Exato de Fisher. Os fatores de risco foram estimados com base nas razoes de chances nao ajustadas e ajustadas, e por meio de analise de correspondencia multipla, com significância para p < 0,05. Resultados: as desordens hipertensivas totalizaram 40,5%; destas, 58,3% tiveram desfecho fetal e neonatal adverso. Mostraram-se significantes para o desfecho os recem-nascidos admitidos na Unidade Terapia Intensiva Neonatal (70,8%), idade gestacional < 32 semanas (41,6%), peso ao nascer < 2500 (66,7%), asfixia neonatal (50%) e desconforto respiratorio precoce (72,2%). Conclusao: prematuridade, asfixia neonatal e desconforto respiratorio precoce constituiram caracteristicas significantes para o desfecho entre os recem-nascidos.

Severe Maternal Morbidity: post-traumatic suffering and social support

OBJECTIVE To assess the relationship of post-traumatic stress symptoms and the perception of social support in women submitted to Severe Maternal Morbidity (SMM). METHOD A prospective cohort study, with 549 women from public hospitals. The Impact of Events and Social Support scales were used. RESULTS Women with SMM were from the State countryside (p=0.046), with low schooling (p=0.039) and did not work (p<0.001). They presented higher consumption of alcoholic beverages (p<0.001), did not perform prenatal (p<0.001), and were older (28.15 ± 28 years). Women with SMM had higher mean values of avoidance behavior (24.32, SD: 4.16), intrusive thinking (18.28, SD: 3.80), lower social support (0.11, SD: 0.001) with large effect size and lower social support satisfaction (0.69; SD: 0.19), with small effect size. CONCLUSION SMM is a differential and negative factor for womens mental health, and social support can favor their coping.

Tempo de transição alimentar na técnica sonda-peito em recém-nascidos baixo peso do Método Canguru.

Purpose Measure the intervention time required for transition from gavage to exclusive oral feeding, comparing newborns exposed exclusively to the mothers breast with those who, in addition to breastfeeding, received supplementation using a cup or baby bottle. Methods Analytical, longitudinal, cohort study conducted with 165 newborns (NB) divided into groups according to severity of medical complications (G1-with no complications; G2-with significant complications), and into subgroups according to feeding mechanism (A and B). All NBs were low birth weight, on Kangaroo Mother Care, and breast stimulated according to medical prescription and hospital routine. Regarding feeding pattern, subgroup A comprised NBs exclusively breastfed at hospital discharge, whereas subgroup B was composed of NBs fed through cup/bottle at some time during hospitalization. The number of days spent in each stage of transition was recorded for each NB. Results History of clinical complications significantly influenced total intervention time. Study participants in subgroups G1-A (10 days), G1-B (9 days), and G2-A (12 days) displayed greater chances of early discharge compared with those in subgroup G2-B (16 days). Conclusion NBs with no important history of clinical complications displayed greater chances of early hospital discharge. NBs with significant history of clinical complications that underwent gavage to exclusive breastfeeding transition presented smaller intervention time than those that required supplementation using cup/bottle. Feeding transition using the gavage-to-exclusive oral feeding technique is recommended for Speech-language Pathology practice in Neonatology.

Construção e validação do Instrumento Avaliação do Autocuidado para pacientes com diabetes mellitus tipo 2

Objective: to construct and validate the contents of the Self-care Assessment instrument for patients with type 2 diabetes mellitus. Method: methodological study, based on Orems General Theory of Nursing. The empirical categories and the items of the instrument were elucidated through a focus group. The content validation process was performed by seven specialists and the semantic analysis by 14 patients. The Content Validity Indices of the items, ≥0.78, and of the scale, ≥0.90, were considered excellent. Results: the instrument contains 131 items in six dimensions corresponding to the health deviation self-care requisites. Regarding the maintenance, a Content Validity Index of 0.98 was obtained for the full set of items, and, regarding the relevance, Content Validity Indices ≥0.80 were obtained for the majority of the assessed psychometric criteria. Conclusion: the instrument showed evidence of content validity.ABSTRACT Objective: to construct and validate the contents of the Self-care Assessment instrument for patients with type 2 diabetes mellitus. Method: methodological study, based on Orems General Theory of Nursing. The empirical categories and the items of the instrument were elucidated through a focus group. The content validation process was performed by seven specialists and the semantic analysis by 14 patients. The Content Validity Indices of the items, ≥0.78, and of the scale, ≥0.90, were considered excellent. Results: the instrument contains 131 items in six dimensions corresponding to the health deviation self-care requisites. Regarding the maintenance, a Content Validity Index of 0.98 was obtained for the full set of items, and, regarding the relevance, Content Validity Indices ≥0.80 were obtained for the majority of the assessed psychometric criteria. Conclusion: the instrument showed evidence of content validity.

Fluxo das Exportações Brasileiras de Cachaça: traços da influência do Estado no setor

Cachaça is considered a genuine Brazilian drink, produced throughout the country and exported to all continents. Given its importance, it is proposed in this paper to describe the stream of the exports, highlighting the importers and producing states, as well as the influence of public policies and legal provisions to encourage the production / trade of this drink. For this study, it was considered a sampling from 1997 to 2015, ranking it among the periods of the administrations of the governments of Fernando Henrique Cardoso, Luis Inácio Lula da Silva and Dilma Rousseff, so that the evolution of exports from forming groups, or clusters, of importing countries based on three periods analyzed, could be evaluated. The results showed that Brazilian cachaça exportations and 1. Data de submissão: 25 de abril de 2016. Data de aceite: 21 de julho de 2017. 2. Universidade Federal de Lavras. Lavras, Minas Gerais, Brasil. E-mail: andrepaiva2@gmail.com 3. Universidade Federal de Viçosa. Viçosa, Minas Gerais, Brasil. E-mail: rosaliabeber@ufv.br 4. Universidade Federal Rural de Pernambuco. Recife, Pernambuco, Brasil. E-mail: daniel.carvalho.ib@gmail.com 5. Universidade Federal de Lavras. Lavras, Minas Gerais, Brasil. E-mail: mozarbrito@gmail.com

Practices and obstetric interventions in women from a state in the Northeast of Brazil

OBJECTIVE To describe practices and interventions used during labor and childbirth and factors associated with such practices in puerperae in the state of Sergipe. METHOD A cross-sectional study with 768 postpartum women from 11 maternity hospitals interviewed 6 hours after delivery, and hospital records review. The associations between best practices and interventions used during labor and delivery with exposure variables were described using simple frequencies, percentages, crude and adjusted odds ratio (ORa) with the confidence interval. RESULTS Of the women in the study, 10.6% received food and 27.8% moved during labor; non-pharmacological methods for pain relief were performed in 26.1%; a partogram was filled in 39.4% of the charts; and an accompanying person was present in 40.6% of deliveries. Oxytocin, amniotomy and labor analgesia were used in 59.1%, 49.3% and 4.2% of women, respectively. Lithotomy position during childbirth was used in 95.2% of the cases, episiotomy in 43.9% and Kristeller maneuver in 31.7%. The variables most associated with cesarean section were private financing (ORa=4.27, 95CI 2.44-7.47), higher levels of education (ORa=4.54, 95CI 2.56-8.3) and high obstetric risk (ORa=1.9, 95CI 1.31-2.74). Women whose delivery was funded privately were more likely to have an accompanying person present (ORa=2.12, 95CI 1.18-3.79) and to undergo labor analgesia (ORa=4.96, 95CI 1.7-14.5). CONCLUSION Best practices are poorly performed and unnecessary interventions are frequent. The factors most associated with c-section were private funding, greater length of education and high obstetric risk.

Óbitos fetais e neonatais de filhos de pacientes classificadas com near miss

Objective: identify the epidemiological aspects of early fetal and neonatal deaths in children of patients classified with near miss and the factors associated with this outcome. Method: a cross-sectional study of 79 women identified with near miss and their newborns. The variables were analyzed using Fishers exact test. Risk factors were estimated based on unadjusted and adjusted odds ratios, and by means of multiple correspondence analysis, with significance for p <0.05. Results: hypertensive disorders totaled 40.5%; Of these, 58.3% had adverse fetal and neonatal outcome. The newborns admitted to the Neonatal Intensive Care Unit proved to be significant for the outcome (70.8%), gestational age <32 weeks (41.6%), birth weight <2500 (66.7%), neonatal asphyxia (50%) and early respiratory discomfort (72.2%). Conclusion: prematurity, neonatal asphyxia, and early respiratory distress were significant characteristics for the outcome among newborns.Objetivo: identificar os aspectos epidemiologicos dos obitos fetais e neonatais precoces em filhos de pacientes classificadas com near miss e os fatores associados a este desfecho. Metodo: estudo transversal realizado com 79 mulheres identificadas com near miss e seus recem-nascidos. As variaveis foram analisadas utilizando-se o teste Exato de Fisher. Os fatores de risco foram estimados com base nas razoes de chances nao ajustadas e ajustadas, e por meio de analise de correspondencia multipla, com significância para p < 0,05. Resultados: as desordens hipertensivas totalizaram 40,5%; destas, 58,3% tiveram desfecho fetal e neonatal adverso. Mostraram-se significantes para o desfecho os recem-nascidos admitidos na Unidade Terapia Intensiva Neonatal (70,8%), idade gestacional < 32 semanas (41,6%), peso ao nascer < 2500 (66,7%), asfixia neonatal (50%) e desconforto respiratorio precoce (72,2%). Conclusao: prematuridade, asfixia neonatal e desconforto respiratorio precoce constituiram caracteristicas significantes para o desfecho entre os recem-nascidos.

Óbitos fetales y neonatales de hijos de pacientes clasificados con near miss

Objective: identify the epidemiological aspects of early fetal and neonatal deaths in children of patients classified with near miss and the factors associated with this outcome. Method: a cross-sectional study of 79 women identified with near miss and their newborns. The variables were analyzed using Fishers exact test. Risk factors were estimated based on unadjusted and adjusted odds ratios, and by means of multiple correspondence analysis, with significance for p <0.05. Results: hypertensive disorders totaled 40.5%; Of these, 58.3% had adverse fetal and neonatal outcome. The newborns admitted to the Neonatal Intensive Care Unit proved to be significant for the outcome (70.8%), gestational age <32 weeks (41.6%), birth weight <2500 (66.7%), neonatal asphyxia (50%) and early respiratory discomfort (72.2%). Conclusion: prematurity, neonatal asphyxia, and early respiratory distress were significant characteristics for the outcome among newborns.Objetivo: identificar os aspectos epidemiologicos dos obitos fetais e neonatais precoces em filhos de pacientes classificadas com near miss e os fatores associados a este desfecho. Metodo: estudo transversal realizado com 79 mulheres identificadas com near miss e seus recem-nascidos. As variaveis foram analisadas utilizando-se o teste Exato de Fisher. Os fatores de risco foram estimados com base nas razoes de chances nao ajustadas e ajustadas, e por meio de analise de correspondencia multipla, com significância para p < 0,05. Resultados: as desordens hipertensivas totalizaram 40,5%; destas, 58,3% tiveram desfecho fetal e neonatal adverso. Mostraram-se significantes para o desfecho os recem-nascidos admitidos na Unidade Terapia Intensiva Neonatal (70,8%), idade gestacional < 32 semanas (41,6%), peso ao nascer < 2500 (66,7%), asfixia neonatal (50%) e desconforto respiratorio precoce (72,2%). Conclusao: prematuridade, asfixia neonatal e desconforto respiratorio precoce constituiram caracteristicas significantes para o desfecho entre os recem-nascidos.

Accuracy of serum IgE concentrations and papule diameter in the diagnosis of cow's milk allergy

OBJECTIVE To compare serum concentrations of specific IgE and mean papule diameters induced in the immediate skin reactivity test with cows milk and its fractions with results of the oral challenge test, and to establish cutoff points capable of predicting clinical reactivity to cows milk in patients treated at a referral service. METHODS One hundred and twenty-two children (median of 17 months) with a history of immediate reactions to cows milk and presence of specific IgE for cows milk and/or its fractions (positive skin and/or IgE serum tests) were submitted to open oral challenge test with cows milk. RESULTS The oral challenge test was positive in 59.8% of the children, 49% of whom were males. Serum levels of specific IgE, as well as mean cows milk papule diameters, were significantly higher in allergic patients (medians: 3.39kUA/L vs. 1.16kUA/L, 2.5mm vs. 0mm). The optimal cutoff points (Youdens index) of serum IgE specific for cows milk and its fractions capable of predicting cows milk reactivity (positive oral challenge test) were: 5.17kUA/L for cows milk, 0.95kUA/L for α-lactalbumin, 0.82kUA/L for β-lactoglobulin, and 0.72kUA/L for casein, whereas for papule diameters the cutoff points were 3.5mm for cows milk and 6.5mm, 9.0mm, and 3.0mm for the α-lactalbumin, β-lactoglobulin, and casein fractions, respectively. CONCLUSIONS The cutoff points capable of predicting clinical reactivity to cows milk were: 5.17kUA/L for serum-specific IgE and 3.5mm for papule diameter measurement, values considered discriminatory for the diagnosis of cows milk allergy.