ABSTRACT
Resumo Este trabalho visou elaborar e validar uma lista de verificação dos processos produtivos de dietas pediátricas para uso em lactários hospitalares. Para a elaboração do instrumento realizou-se pesquisa bibliográfica. A validação do conteúdo foi realizada com 5 especialistas, pela Técnica Delphi - utilizando a escala Likert de 5 pontos. A validação de aparência foi realizada por 3 nutricionistas, no mesmo ambiente, dia e horário. O instrumento incluiu cabeçalho, guia de instruções de preenchimento e 225 itens de avaliação que obtiveram o conteúdo validado. Os valores mínimos e máximos para o índice de validade de conteúdo (IVC) foi, respectivamente, 0,88 e 0,96. O coeficiente de correlação intraclasse (CCI) e Alfa de Cronbach (α) foi >0,80 em mais de 90% dos itens avaliados. Os valores mínimos e máximos para o índice de validade de aparência (IVA) foi, respectivamente, 0,73 e 0,93. O teste de Kruskal Wallis não apresentou diferença significativa durante as avaliações (p valor>0,05) para os blocos da versão rotina e versão gestão. As versões do instrumento apresentaram em mais de 80% dos blocos α e CCI>0,80. Portanto, o instrumento apresentou conteúdo e aparência validados tendo reprodutibilidade e confiabilidade, ou seja, viabilidade de utilização na prática do nutricionista.
Abstract This work aimed to draft and validate a checklist of the production processes of pediatric diets for use in hospital lactaries. A bibliographic search was carried out in order to draft the instrument. Content validation was performed with 5 experts, using the Delphi technique and the 5-point Likert scale. Appearance validation was performed by 3 nutritionists, in the same environment, day, and time. The instrument included a header, a guide to completion instructions, and 225 assessment items that obtained validated content. The minimum and maximum values for the content validity index (CVI) were 0.88 and 0.96, respectively. The intraclass correlation coefficient (ICC) and Cronbach's alpha (α) was >0.80 in more than 90% of the items evaluated. The minimum and maximum values for the Appearance Validity Index (AVI) were, respectively, 0.73 and 0.93. The Kruskal Wallis test showed no significant difference during the evaluations (p-value>0.05) for the blocks of the routine version and the management version. The instrument versions presented in more than 80% of the α and ICC blocks > 0.80. Therefore, the instrument presented validated content and appearance, presenting reproducibility and reliability in terms of the feasibility of use in a nutritionist's practice.
ABSTRACT
Introducción: Los lactarios iniciaron sus actividades en los hospitales de nuestro medio, con el objetivo de contribuir al mantenimiento del estado nutricional y a la recuperación de la salud de los pacientes hospitalizados, a través de una intervención nutricional de excelencia técnica. Objetivo: Caracterizar los Lactarios de Hospitales de Referencia de Asunción y Central, durante el periodo 2014, para establecer un diagnóstico de la situación de adecuación de los mismos a las normas internacionales. Materiales y Métodos: Diseño descriptivo, observacional. Se utilizó una encuesta a partir del documento "Orientaciones técnicas para Servicios Dietéticos de Leche (SEDILE) y Central de Fórmula Enteral (CEFE) del Ministerio de Salud de Chile. Se realizó observación directa de los lactarios y encuesta a los profesionales encargados. Estadística: A cada variable de las dimensiones evaluadas en los lactarios se le asignó una puntuación de acuerdo a la presencia (1) o ausencia (0) de la característica estudiada y estos resultados se compararon al 100% de los datos del instrumento de recolección. Las variables obtenidas fueron cualitativas, dicotómicas (presencia o ausencia) y para su descripción se utilizó la distribución de frecuencia en porcentajes. Para las variables cuantitativas se utilizaron las medidas de tendencia central y dispersión. Resultados: Ingresaron al estudio siete lactarios de hospitales públicos, dos de los cuales fueron para extracción de leche materna. En relación a la disponibilidad de: 1) Recursos físicos: el porcentaje (%) global fue del 55% (rango 38-80%). 2) Equipamiento: el % global fue del 42% (rango 27-62%). 3) Manual de funciones y organigrama: el % global fue del 55% (rango 25-75%). 4) Normas y procedimientos: el % global fue del 59% (rango 27-80%). Conclusiones: La dimensión más afectada en los lactarios evaluados fue el equipamiento, seguida de recursos físicos y la disponibilidad de manual de funciones y organigrama.
Introduction: The lactary became active in Paraguayan hospitals to contribute to maintain or restore the nutritional health of hospitalized patients through nutritional intervention. Objetive: To characterize the lactary operating at reference hospitals in Asuncion and the Central Department, in 2014, to determine their adequacy to international standards. Materials and Methods: We conducted a descriptive and observational study by direct observation of the lactary and a survey, based on the guidelines of SEDILE (technical guidelines for dietary milk services) and CEFE (enteric formula center). Statistics: Each variable assessed by SEDILE criteria was assigned a point value according to the presence (1) or absence (0) of the particular criterion and compared to the total data collected in the survey. Variables determined were qualitative and binary (presence or absence), and described with percentage frequency distribution. Central tendency and dispersion measures were used for quantitative variables. Results: Seven lactary from public hospitals were included, of which two were dedicated to extraction of breast milk. Overall availability of physical resources was 55% (range 38-80%), of equipment, 42% (range, 27-62%), of organization charts and job description manuals, 55% (range, 25-75%), and standard and procedures manuals 59% (range, 27-80%). Conclusions: The greatest shortfall in the lactary studied was of equipment, followed by physical resources and organization and job function manuals.
ABSTRACT
Introducción: La lactancia materna exclusiva es ideal para el recién nacido por su aporte nutricional, inmunológico y emocional, todos ellos fundamentales para su adecuado crecimiento y desarrollo. Se ha observado que, el trabajo es el factor más influyente que condiciona el abandono. Se hace necesario evaluar el impacto del lactario domiciliario para reducir el abandono de la lactancia materna exclusiva en madres trabajadoras. Métodos: Estudio aplicativo de tipo experimental, prospectivo, transversal analítico realizado en el Servicio de Maternidad del Hospital Central de San Cristóbal. Se seleccionaron aquellas madres trabajadoras de la localidad dispuestas a lactar, aplicándose un programa de creación y funcionamiento del lactario domiciliario. Posteriormente se verificó la continuidad del programa en su domicilio durante dos meses y se compararon los resultados con las madres trabajadoras que no recibieron este entrenamiento. Resultados: Las madres trabajadoras que crearon el lactario domiciliario presentaron un porcentaje de abandono menor (28)% que aquellas que no lo tenían (60%) (p<0,001). Entre las madres que abandonaron la lactancia materna, el trabajo fue la principal causal en el grupo sin lactario (57%) y la hipogalactia en el grupo con lactario (22%). El trabajo como causal de abandono se redujo considerablemente al instaurarse el lactario domiciliario (p <0,001) Discusión: La creación de lactarios domiciliarios disminuye significativamente el abandono de la lactancia materna en madres trabajadoras. El fomento de este tipo de estrategias es una alternativa para fortalecer la lactancia materna exclusiva por mayor tiempo.
Introduction: Exclusive breastfeeding is ideal for the newborn baby because of its nutritional, immunological and emotional contribution, key elements for adequate growth and development. It is recognized that return to work is the most influential factor for the abandonment of breastfeeding. It is necessary to assess the impact of the home lactary in the reduction of the abandonment of exclusive breastfeeding. Methods: An applicative study of experimental, prospective, cross case and analytical type was conducted in the Maternity Service of the San Cristobal Central Hospital. Working mothers willing to breast-feed were selected and a program for the creation and development of a home lactary was implemented; continuity of the home program was verified during the two subsequent months. Results were compared with mothers who did not receive this training. Results: Working mothers who created the home lactary presented a lower percentage of breast feeding abandonment (28) % in comparison with those who did not (60%). (p<0, 001). Among mothers who gave up breastfeeding, returning to work was the main cause in the group with no lactary (57%) and milk insufficiency was the main cause in the group with a lactary (22%). Returning to work as cause for abandonment dropped significantly with the creation of a lactary (p< 0.001) Discussion: The creation of a home lactary decreases significantly the rate of abandonment of breastfeeding in working mothers. The promotion of this type of strategies is an alternative to strengthen the prolongation of exclusive breastfeeding.