Breastfeeding assistance for preterm and low birth weight infants: best practices implementation project.

OBJECTIVE: To describe the process of best practices implementation for breastfeeding assistance for preterm and low birth weight infants. METHOD: Participatory research that used the evidence implementation methodology of the JBI, held at a university hospital in southeastern Brazil, with the participation of a multidisciplinary team and managers. STAGES: Situational diagnosis, baseline audit and feedback, protocol development, training, implementation, and monitoring. RESULTS: Seven audit criteria were defined. In the baseline audit, three criteria were met, with eleven barriers to be resolved being listed. The strategies carried out were protocol development and multidisciplinary and intersectoral training. After the training, compliance was achieved with the seven criteria audited in the first follow-up audit and five in the second, emphasizing the increase in compliance after the implementation of the outlined strategies. CONCLUSION: The project achieved the objective of improving evidence-based practice, and allowed the implementation of the institution's first breastfeeding protocol. However, it shows the need to maintain training for adherence and enculturation of new practices.

Stress and exhaustion among medical students: a prospective longitudinal study on the impact of the assessment period on medical education.

BACKGROUND: Stress significantly affects both the physical and emotional health of individuals, particularly students in health-related fields. Medical students in Brazil face unique challenges due to the demanding nature of their studies, especially during assessment periods, which heighten academic pressure. These pressures often lead to poor coping strategies and mental health concerns. It is crucial to understand the complex dynamics of stress within medical education to develop strategies that improve student well-being and promote a healthier academic environment. This study aims to investigate the intricate relationship between assessment periods and stress levels among medical students. It seeks to understand how academic demands and sociodemographic factors contribute to stress dynamics during these periods. METHODS: An online observational, longitudinal, and prospective study was conducted from February to October 2022. Medical students were recruited through snowball sampling and participated in surveys administered via Google Forms at two timepoints: before (T1) and during (T2) assessment periods. The surveys collected sociodemographic data and stress symptoms using Lipp's Inventory of Stress Symptoms for Adults (LSSI). RESULTS: The transition from T1 to T2 was defined by a rise in the prevalence of stress from 59.6 to 84.2% (p = 0.001) and a decline in symptom-free students from 40.4 to 15.8% (p = 0.001). There was a significant increase in exhaustion, from 12.3 to 31.6% (p = 0.0001). Higher stress levels were notably more prevalent among younger students (≤ 24 years), females, those from wealthier families, students without scholarships, those without prior degrees, and those in the clinical phase of their studies. However, non significant correlations were found between these sociodemographic and academic factors and the increase in stress. CONCLUSION: The findings highlight significant concerns regarding the mental health of medical students during assessment periods, marked by increased stress and exhaustion levels. These results emphasize the need for proactive interventions to manage stress effectively in medical education, considering its profound impact on students' well-being.

Puerperal women's social interactions related to their sexual health after childbirth.

OBJECTIVE: To analyze puerperal women's experiences of sexual health after childbirth from the perspective of symbolic interactionism. METHOD: Descriptive, qualitative study. Twenty semi-structured interviews were conducted by videoconference with women in the remote puerperium, captured by snowball technique and searched for "seeds" on Instagram®. Bardin's content analysis and Symbolic Interactionism were used as references. RESULTS: The puerperal women signify sexual health from a perspective of comprehensive healthcare. However, due to the duality between "being a woman" and "being a mother", they recognize fear, bodily transformations and changes in focus from the love relationship to caring for the baby as factors that interfere with sexual health. And they choose to put themselves aside, prioritizing caring for others. They re-signify sexual health by recognizing the importance of taking care of themselves in biopsychosocial aspects and try to recover self-care for a healthy sexual experience. CONCLUSION: Despite the meanings attributed, women's social interactions with the puerperium interfere negatively with sexual health. Professionals should be sensitized to the inclusion of actions that promote changes in the social action of these women towards self-care.

Currículos inovadores na formação médica: a percepção dos estudantes sobre metodologias ativas de ensino-aprendizagem

Objetivo: Avaliar a percepção de estudantes de Medicina quanto ao emprego de currículos inovadores no seu processo de aprendizagem, analisando a interferência do perfil sociodemográfico e acadêmico. Métodos: Estudo transversal, realizado através de questionário virtual, estruturado, anônimo, de autopreenchimento, respondido por estudantes de Medicina em Salvador/Bahia. Além da percepção quanto ao uso de currículos inovadores, avaliou-se o perfil sociodemográfico e acadêmico. Resultados: Foram avaliados 253 estudantes de Medicina, com predomínio do sexo feminino (62,8%), da raça branca (54,9%), solteiros (88,1%), com idade de 23,9+4,9 anos, sem formação acadêmica prévia (79,1%). Os estudantes reconhecem que o emprego de currículos inovadores auxilia na consolidação do conhecimento (90,5%), principalmente por permitir uma vivência profissional precoce (90,5%), contribuir na capacidade de reflexão (92,9%), no desenvolvimento do raciocínio clínico (94,1%), na interação entre teoria e prática (90,9%) e proporcionar maior segurança quanto ao aprendizado (80,2%). Os aspectos sociodemográficos não interferiram nessas percepções, entretanto aspectos acadêmicos, como formação prévia e método tradicional na graduação anterior, associaram-se com menor grau de concordância acerca dos benefícios acadêmicos dos currículos inovadores. Conclusão: Os estudantes de Medicina reconhecem que as metodologias ativas contribuem para o processo de aprendizagem por proporcionar uma vivência profissional precoce e a articulação entre teoria e prática, estimulando a capacidade de reflexão e o raciocínio clínico.

Impacto da pandemia de COVID-19 na prevalência de transtornos mentais comuns entre estudantes de Medicina / Impact of the COVID-19 pandemic on the prevalence of common mental disorders among medical students

RESUMO Objetivo: Analisar se houve impacto da pandemia de COVID-19 na prevalência de transtornos mentais comuns (TMCs) entre estudantes de Medicina, investigando os possíveis fatores de risco associados. Métodos: Estudo observacional, desenvolvido com 289 estudantes de Medicina de Salvador, Bahia, realizado antes e durante a pandemia da COVID-19. Utilizou-se um questionário estruturado contendo dados sociodemográficos, acadêmicos e sobre hábitos de vida. O rastreamento de TMC foi realizado por meio do Self-Report Questionnaire (SRQ-20). A coleta de dados ocorreu em duas etapas: a primeira, presencial (período anterior à pandemia) e a segunda, virtual (período pandêmico). Resultados: Não houve diferença na prevalência de TMC entre os momentos antes e durante a pandemia (48,0% vs. 44,5%, p = 0,577). Durante a pandemia, verificou-se aumento do envolvimento religioso (80,6% vs. 92,7%, p = 0,002) e do consumo de bebidas alcoólicas (45,9% vs. 69,1%, p < 0,001). Entre os estudantes, observou-se aumento de TMC entre homens (17,0% vs. 34,1%, p = 0,036); redução entre mulheres (83,0% vs. 65,9%, p = 0,036); aumento entre aqueles com envolvimento religioso (80,9% vs. 92,9%, p = 0,036); e aumento em todos os ciclos acadêmicos (p = 0,039). Conclusão: Apesar de a prevalência de TMC em estudantes de Medicina manter-se expressiva, não foi demonstrado impacto direto da pandemia de COVID-19 em suas taxas. Ademais, a prevalência de TMC foi maior entre os estudantes com engajamento religioso e consumidores de bebida alcoólica.

ABSTRACT Objective: To analyze whether there was an impact of the COVID-19 pandemic on the prevalence of common mental disorders (CMD) among medical students, investigating the possible associated risk factors. Methods: It is an observational study, developed with 289 medical students from Salvador, Bahia, carried out before and during the COVID-19 pandemic. A structured questionnaire containing sociodemographic, academic and lifestyle data was used. CMD screening was performed using the Self-Report Questionnaire (SRQ-20). Data collection took place in two stages: the first in person (period before the pandemic) and the second virtual (pandemic period). Results: There was no difference in the prevalence of CMD between the moments before and during the pandemic (48.0% vs. 44.5%, p = 0.577). During the pandemic, there was an increase in religious involvement (80.6% vs. 92.7%, p = 0.002) and consumption of alcoholic beverages (45.9% vs. 69.1%, p < 0.001). Among students, there was an increase in CMD among men (17.0% vs. 34.1%, p = 0.036); reduction among women (83.0% vs. 65.9%, p = 0.036); increase among those with religious involvement (80.9% vs. 92.9%, p = 0.036); and increase in all academic cycles (p = 0.039). Conclusion: Although the prevalence of CMD in medical students remains expressive, there was no direct impact of the COVID-19 pandemic on its rates. In addition, the prevalence of CMD was higher among students with religious commitment and alcohol drinkers.

Puerperal women's social interactions related to their sexual health after childbirth / Interacciones sociales de mujeres puérperas relacionadas con su salud sexual después del parto / Interações sociais de puérperas relacionadas à sua saúde sexual após o parto

ABSTRACT Objective: To analyze puerperal women's experiences of sexual health after childbirth from the perspective of symbolic interactionism. Method: Descriptive, qualitative study. Twenty semi-structured interviews were conducted by videoconference with women in the remote puerperium, captured by snowball technique and searched for "seeds" on Instagram®. Bardin's content analysis and Symbolic Interactionism were used as references. Results: The puerperal women signify sexual health from a perspective of comprehensive healthcare. However, due to the duality between "being a woman" and "being a mother", they recognize fear, bodily transformations and changes in focus from the love relationship to caring for the baby as factors that interfere with sexual health. And they choose to put themselves aside, prioritizing caring for others. They re-signify sexual health by recognizing the importance of taking care of themselves in biopsychosocial aspects and try to recover self-care for a healthy sexual experience. Conclusion: Despite the meanings attributed, women's social interactions with the puerperium interfere negatively with sexual health. Professionals should be sensitized to the inclusion of actions that promote changes in the social action of these women towards self-care.

RESUMEN Objetivo: Analizar las experiencias de salud sexual de las puérperas después del parto desde la perspectiva del interaccionismo simbólico. Método: Estudio descriptivo y cualitativo. Se realizaron 20 entrevistas semiestructuradas por videoconferencia con mujeres puérperas a distancia, captadas mediante bola de nieve y búsqueda de las "semillas" a través de Instagram®. Se utilizaron como referencias el análisis de contenido de Bardin y el Interaccionismo Simbólico. Resultados: Las puérperas significan la salud sexual desde una perspectiva de atención sanitaria integral. Sin embargo, debido a la dualidad entre "ser mujer" y "ser madre", reconocen el miedo, las transformaciones corporales y los cambios de enfoque de la relación amorosa al cuidado del bebé como factores que interfieren en la salud sexual. Y deciden dejarse a un lado, dando prioridad al cuidado de los demás. Resignifican la salud sexual reconociendo la importancia de cuidarse en los aspectos biopsicosociales e intentan recuperar el autocuidado para una experiencia sexual saludable. Conclusión: A pesar de los significados atribuidos, las interacciones sociales de las mujeres con el puerperio interfieren negativamente en la salud sexual. Los profesionales deben ser sensibilizados para la inclusión de acciones que promuevan cambios en las acciones sociales de estas mujeres hacia el autocuidado.

RESUMO Objetivo: Analisar experiências de puérperas sobre saúde sexual após o parto na perspectiva do interacionismo simbólico. Método: Estudo descritivo, qualitativo. Realizadas 20 entrevistas semiestruturadas por videoconferência com mulheres no puerpério remoto, captação por "snowball" e busca das "sementes" pelo Instagram®. Utilizou-se a análise de conteúdo de Bardin e o Interacionismo Simbólico como referencial. Resultados: As puérperas significam saúde sexual numa perspectiva de integralidade dos cuidados em saúde. Contudo, pela dualidade entre o "ser mulher" e o "ser mãe", reconhecem o medo, as transformações corporais e as mudanças de foco da relação amorosa para os cuidados com o bebê como fatores que interferem na saúde sexual. E, escolhem se deixar de lado, priorizando o cuidado com os outros. Ressignificam saúde sexual pelo reconhecimento da importância de cuidar de si nos aspectos biopsicossociais e tentam resgatar o autocuidado para vivência sexual saudável. Conclusão: Apesar dos significados atribuídos, as interações sociais das mulheres com o puerpério interferem negativamente na saúde sexual. Profissionais devem ser sensibilizados quanto à inclusão de ações que promovam mudanças da ação social dessas mulheres para o cuidado de si.

Experiences of health professionals in screening for postpartum depressive symptoms: a qualitative systematic review protocol.

OBJECTIVE: This review will assess and synthesize the available qualitative evidence on the experiences of health professionals in screening for postpartum depression. INTRODUCTION: Postpartum depression is a significant public health problem. Clinical screening is essential to develop appropriate interventions to meet the needs of women and their families. The findings of this review will have important implications for decision-making and policy development for continuous professional development programs that promote evidence-based postpartum depression screening. INCLUSION CRITERIA: This review will consider studies that explore the experiences of health professionals who screen for postpartum depression in any geographic location at any health care level (primary, secondary, or tertiary). The review will focus on qualitative data, including methods such as phenomenology, grounded theory, ethnography, action research, and feminist research. METHODS: The review will follow a 3-step search strategy, in line with the JBI methodology for systematic reviews of qualitative evidence. The databases to be searched will include MEDLINE, CINAHL, Embase, Scopus, LILACS, ScienceDirect, PsycINFO, Index Psi Periódicos, and PePsic. Unpublished studies will be searched for in Google Scholar, Cybertesis, Dart-E, EthOS, and OATD. Two independent reviewers will evaluate the included studies for methodological quality and extract data using the JBI data extraction and synthesis tools. There will be no language or date limitations. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021253792.

Sofrimento mental puerperal: conhecimento da equipe de enfermagem / Mental distress during the puerperium: the nursing team's knowledge / Sufrimiento mental durante el puerperio: conocimiento del equipo de enfermería

RESUMO Objetivo: avaliar o conhecimento da equipe de enfermagem do alojamento conjunto sobre sofrimento mental puerperal e oferecer subsídios para ações educativas. Método: estudo descritivo, quantitativo, realizado com 30 profissionais de enfermagem em hospital público de ensino, em São Paulo - BR. Os dados foram coletados entre dezembro de 2020 e janeiro de 2021 por meio de questionário estruturado e analisados de forma descritiva. Resultados: 73,3% das enfermeiras obstétricas, técnicas e auxiliares de enfermagem tinham idade ≥40 anos e 80% tinham tempo de atuação ≥cinco anos. Predominou o conhecimento sobre o papel da enfermagem e as práticas na assistência ao sofrimento mental puerperal (maioria de respostas esperadas em 80% das questões), em contraposição ao conhecimento sobre fisiopatologia, sintomas e causas de blues, depressão e psicose puerperal (maioria de respostas esperadas em 40% das questões). Conclusão: os resultados podem subsidiar a educação permanente, visando ampliar o conhecimento da equipe de enfermagem e fortalecer o processo de cuidar.

ABSTRACT Objective: to assess the Rooming-In Nursing team's knowledge about mental distress during the puerperium and to offer subsidies for educational actions. Method: a descriptive and quantitative study carried out with 30 Nursing professionals from a public teaching hospital in São Paulo, Brazil. The data were collected between December 2020 and January 2021 using a structured questionnaire and analyzed descriptively. Results: 73.3% of the nurse-midwives, nurses, and nursing technicians and assistants were aged ≥40 years old, and 80% had more than five years of working time. There was a predominance of knowledge about the role of Nursing and its respective practices in the assistance provided in cases of mental distress during the puerperium (majority of expected answers in 80% of the questions), in contrast to the knowledge about pathophysiology, symptoms and causes of puerperal blues, depression and psychosis (majority of expected answers in 40% of the questions). Conclusion: the results can support permanent education, aiming to expand the Nursing team's knowledge and strengthen the care process.

RESUMEN Objetivo: evaluar el conocimiento del equipo de Enfermería del área de Alojamiento Conjunto con respecto al sufrimiento mental durante el puerperio y ofrecer elementos de apoyo para acciones educativas. Método: estudio descriptivo y cuantitativo realizado con 30 profesionales de Enfermería en un hospital público de enseñanza de San Pablo, Brasil. Los datos se recolectaron entre diciembre de 2020 y enero de 2021 por medio de un cuestionario estructurado y se los analizó en forma descriptiva. Resultados: el 73,3% de las enfermeras especializadas en Obstetricia, técnicas y auxiliares de Enfermería tenían al menos 40 años y el 80% estaba activa en la profesión hacía al menos cinco años. Predominó el conocimiento sobre el rol y las prácticas de Enfermería en la atención provista en casos de sufrimiento mental durante el puerperio (mayoría de respuestas esperadas en el 80% de las preguntas), en contraste con el conocimiento sobre la fisiopatología, los síntomas y las causas del blues, la depresión y la psicosis puerperal (mayoría de respuestas esperadas en el 40% de las preguntas). Conclusión: los resultados pueden sustentar la educación permanente, con vistas a ampliar el conocimiento del equipo de Enfermería y fortalecer el proceso de atención.

Implementation of evidence-based practices in the perineal pain management in the postpartum period / Implementación de prácticas basadas en evidencias para manejar el dolor perineal durante el período posparto / Implementação de práticas baseadas em evidências no manejo da dor perineal no período pós-parto

ABSTRACT Objectives: To implement strategies for managing perineal pain in puerperal women admitted to a public maternity hospital in São Paulo state and to evaluate their compliance with evidence-based practices. Methods: Implementation study using the JBI model conducted with nursing professionals and puerperal women between September and December 2019. Interviews with puerperal women and medical record data were used to audit seven evidence-based criteria. The interventions adopted included a care protocol, professional training, and folder elaboration for puerperal women. Results: Prior to the intervention, deficits in audited practices and obstacles to pain management were identified, which were overcome by the strategies employed. The follow-up audit demonstrated improvements in compliance with best care practices. Conclusion: There was an increase in the criteria compliance evaluated after the implemented strategies, contributing to improving the nursing care results in the perineal pain management based on the best scientific evidence.

RESUMEN Objetivos: Implementar estrategias para manejar el dolor perineal en puérperas en una maternidad pública de São Paulo y evaluar su conformidad con prácticas basadas en evidencias. Métodos: Estudio de implementación realizado mediante el modelo JBI con profesionales de enfermería y puérperas, entre septiembre-diciembre de 2019. Se utilizaron entrevistas con puérperas y datos de registros hospitalarios para auditar siete criterios basados en evidencias. Las intervenciones fueron: protocolo de atención; capacitación de los profesionales; preparación de una carpeta para puérperas. Resultados: Antes de la intervención, se identificaron déficits en las prácticas y barreras en el manejo del dolor, que se superaron con las estrategias empleadas. La auditoría de seguimiento trajo mejoras en el cumplimiento de las prácticas de cuidado. Conclusiones: Hubo aumento en la conformidad de los criterios evaluados tras las estrategias implementadas, lo que contribuyó a mejorar la atención de enfermería en el manejo del dolor perineal basada en evidencias científicas.

RESUMO Objetivos: Implementar estratégias de manejo da dor perineal em puérperas internadas em uma maternidade pública do estado de São Paulo e avaliar sua conformidade com as práticas baseadas em evidências. Métodos: Estudo de implementação que utilizou o modelo do JBI, realizado com profissionais de enfermagem e puérperas, entre setembro e dezembro de 2019. Utilizaram-se entrevistas com puérperas e dados de prontuário para auditar sete critérios baseados em evidências. As intervenções adotadas foram um protocolo de cuidados, treinamento de profissionais e elaboração de folder para puérperas. Resultados: Antes da intervenção, identificaram-se déficits nas práticas auditadas e barreiras ao manejo da dor, que foram superadas pelas estratégias empregadas. A auditoria de seguimento demonstrou melhorias no cumprimento das melhores práticas de cuidado. Conclusões: Houve aumento da conformidade dos critérios avaliados após as estratégias implementadas, contribuindo para melhora dos resultados da assistência de enfermagem no manejo da dor perineal baseada nas melhores evidências científicas.

Implementation of evidence-based practices in the perineal pain management in the postpartum period.

OBJECTIVES: To implement strategies for managing perineal pain in puerperal women admitted to a public maternity hospital in São Paulo state and to evaluate their compliance with evidence-based practices. METHODS: Implementation study using the JBI model conducted with nursing professionals and puerperal women between September and December 2019. Interviews with puerperal women and medical record data were used to audit seven evidence-based criteria. The interventions adopted included a care protocol, professional training, and folder elaboration for puerperal women. RESULTS: Prior to the intervention, deficits in audited practices and obstacles to pain management were identified, which were overcome by the strategies employed. The follow-up audit demonstrated improvements in compliance with best care practices. CONCLUSION: There was an increase in the criteria compliance evaluated after the implemented strategies, contributing to improving the nursing care results in the perineal pain management based on the best scientific evidence.

Brucella Infection Investigation in Cetaceans and Manatees in Northeast Brazil.

Among the bacterial infections that impair the health status of marine mammals, those caused by Brucella spp. are the most reported worldwide. Brucella infections in marine mammals can result in acute or chronic disease and are associated with variable clinical outcomes, depending on the organ involved during the infectious process, infection route, host immunity, and strain pathogenicity. Asymptomatic infections may also occur. The current study expands the investigation of Brucella infection in northeast Brazil by analyzing 19 dead, stranded cetaceans and 52 Antillean manatees Trichechus manatus manatus. The manatees included 8 dead, captive manatees and 44 live specimens, of which 10 were analyzed only after reintroduction into the wild as part of a rehabilitation program, 9 were analyzed both while in captivity or semi-captivity and after reintroduction, 20 were sampled only in captivity or semi-captivity, and 5 were free-living manatees. Serological tests were used to screen for antibodies against smooth Brucella spp. Whole blood, swabs, and tissue samples were screened for Brucella spp. DNA by PCR. Samples with positive PCR results were cultured for Brucella spp. isolation. All manatees yielded negative results in serological and molecular tests. Brucella spp. DNA was detected in the kidney of one adult Guiana dolphin Sotalia guianensis exhibiting necrosis in the liver. No growth of Brucella spp. was observed via microbiological culturing. This study is the first report of Brucella spp. DNA detection in cetaceans in the state of Pernambuco, and it highlights the importance of conducting systematic monitoring for the presence of Brucella infection in marine mammals along the Brazilian coast, especially in the northeast region, where several cases have been reported.

Prevalence, characteristics, and impact of pain during the postpartum period.

OBJECTIVE: To identify the prevalence of pain in puerperal women, describe the characteristics of pain and its impacts on the performance of daily life activities, and evaluate satisfaction with received analgesia. METHOD: Cross-sectional study which included women who had given birth. These were evaluated within 72 hours postpartum in a public teaching hospital in São Paulo city. Obstetric and clinical data were evaluated, as well as presence and characteristics of pain and its impact on daily activities. RESULTS: A total 128 women participated in this study. The prevalence of pain was 36.7% during the interview and 54.6% in the previous 24 hours. The main pain site was the abdominal region (64.7%) and pain intensity was moderate to 48.9% of women, with intermittent frequency in 58% of the cases. There was a significant association between presence of pain and type of delivery (cesarean; p=0.030). Not being able to provide care to the newborn, requiring going to a different unit, increased pain perception (p=0.038). A significant impact of pain on the capacity of walking, eating, sleeping, taking care of the baby, evacuating, breathing deeply, breastfeeding, and sitting was verified. CONCLUSION: Pain was frequent during the postpartum period and significantly affected the mothers' activities, indicating a need for improving pain management in puerperium.

Prevalence, characteristics, and impact of pain during the postpartum period / Prevalencia, características y repercusión del dolor en el período de posparto / Prevalência, características e impacto da dor no período pós-parto

ABSTRACT Objective: To identify the prevalence of pain in puerperal women, describe the characteristics of pain and its impacts on the performance of daily life activities, and evaluate satisfaction with received analgesia. Method: Cross-sectional study which included women who had given birth. These were evaluated within 72 hours postpartum in a public teaching hospital in São Paulo city. Obstetric and clinical data were evaluated, as well as presence and characteristics of pain and its impact on daily activities. Results: A total 128 women participated in this study. The prevalence of pain was 36.7% during the interview and 54.6% in the previous 24 hours. The main pain site was the abdominal region (64.7%) and pain intensity was moderate to 48.9% of women, with intermittent frequency in 58% of the cases. There was a significant association between presence of pain and type of delivery (cesarean; p=0.030). Not being able to provide care to the newborn, requiring going to a different unit, increased pain perception (p=0.038). A significant impact of pain on the capacity of walking, eating, sleeping, taking care of the baby, evacuating, breathing deeply, breastfeeding, and sitting was verified. Conclusion: Pain was frequent during the postpartum period and significantly affected the mothers' activities, indicating a need for improving pain management in puerperium.

RESUMEN Objetivo: Identificar la prevalencia del dolor en las puerperales, describir las características y el impacto del dolor en el desempeño de las actividades de la vida diaria y evaluar la satisfacción con la analgesia recibida. Método: Estudio transversal que incluyó a mujeres que dieron a luz, evaluadas hasta dentro de las 72 horas de posparto en un hospital público de enseñanza en la ciudad de São Paulo. Se evaluaron los datos clínicos y obstétricos, así como la presencia, las características y el impacto del dolor en las actividades cotidianas. Resultados: Participaron 128 mujeres. La prevalencia del dolor fue del 36,7% en el momento de la entrevista y del 54,6% en las 24 horas precedentes. El principal lugar de dolor era la región abdominal (64,7%) y la intensidad del dolor fue moderada para el 48,9% de las mujeres, con una frecuencia intermitente en el 58% de los casos. Hubo una asociación significativa entre la presencia de dolor y el tipo de parto (cesáreo; p=0,030). El no cuidar al recién nacido por tener que trasladarse a otra unidad aumentaba la percepción del dolor (p=0,038). Hubo un impacto significativo del dolor en la capacidad de caminar, comer, dormir, cuidar del bebé, evacuar, respirar profundamente, amamantar y sentarse. Conclusión: El dolor era frecuente en el período de posparto y afectaba significativamente a las actividades de la madre, lo que indica la necesidad de mejorar el tratamiento del dolor en el puerperio.

RESUMO Objetivo: Identificar a prevalência de dor em puérperas, descrever as características e o impacto da dor no desempenho das atividades de vida diária e avaliar a satisfação com a analgesia recebida. Método: Estudo transversal que incluiu mulheres que deram à luz, avaliadas em até 72 horas pós-parto em hospital público de ensino da cidade de São Paulo. Foram avaliados dados clínicos e obstétricos, bem como presença, características e impacto da dor nas atividades diárias. Resultados: Participaram 128 mulheres. A prevalência de dor foi 36,7% no momento da entrevista e 54,6% nas últimas 24 horas. O principal local de dor foi a região abdominal (64,7%) e a intensidade da dor foi moderada para 48,9% das mulheres, com frequência intermitente em 58% dos casos. Houve associação significativa entre a presença de dor e o tipo de parto (cesariana; p=0,030). Não prestar cuidado ao recém-nascido, tendo que se deslocar para outra unidade, aumentou a percepção de dor (p=0,038). Verificou-se impacto significativo da dor na capacidade de caminhar, comer, dormir, cuidar do bebê, evacuar, respirar fundo, amamentar e sentar-se. Conclusão: A dor foi frequente no período pós-parto e afetou significativamente as atividades maternas, indicando necessidade de se aprimorar o manejo da dor no puerpério.

Valeriana officinalis Counteracts Rotenone Effects on Spreading Depression in the Rat Brain in vivo and Protects Against Rotenone Cytotoxicity Toward Rat Glioma C6 Cells in vitro.

Astrocytes can protect neurons against oxidative stress and excitability-dependent disorders, such as epilepsy. Valeriana officinalis has been used as anticonvulsant and can exert an antioxidant effect, which may underlie its opposing action against the toxic effects of the pesticide rotenone. We investigated the V. officinalis /rotenone interaction in the cortical spreading depression (CSD), a phenomenon that depends upon brain excitability (in vivo model). In addition, we analyzed the protective action of V. officinalis against the cytotoxic effects of rotenone in cultures of rat C6 glioma cells (in vitro model). For the CSD study, Wistar rats received either V. officinalis (250 mg/kg/day via gavage for 15 days; n = 8) or 10 mg/kg/day rotenone via subcutaneous injections for 7 days (n = 7), or they received both substances (n = 5). Two control groups received either saline (vehicle for V. officinalis; n = 8) or 1% Tween-80 aqueous solution (vehicle for rotenone; n = 9). After treatment, CSD was recorded for 4 h. The rotenone- and V. officinalis-treated groups presented, respectively, with lower (2.96 ± 0.14 mm/min), and higher CSD propagation velocity (3.81 ± 0.10 mm/min) when compared with the controls (Tween-80, 3.37 ± 0.06 mm/min and saline, 3.35 ± 0.08 mm/min; p < 0.05). The rotenone plus V. officinalis-treated group displayed a CSD velocity (3.38 ± 0.07 mm/min) that was similar to controls. In line with these results, in vitro experiments on rat glioma C6 cells revealed a protective effect (MTT assay) of V. officinalis against rotenone-induced cytotoxicity. These results suggest the therapeutic potential of V. officinalis for treating neurological diseases involving redox imbalance and astrocyte dysfunction.

Enfermagem no contexto familiar na prevenção de anomalias congênitas: revisão integrativa / Nursing in the family context in the prevention of congenital anomalies: integrative review

Introdução: a anomalia congênita é uma malformação na estrutura ou função que estão presentes no nascimento e durante o pré-natal. Estima-se que, todos os anos, 303.000 recém-nascidos morrem nas primeiras 4 semanas de nascimento devido a anomalias congênitas. Objetivo: discutir sobre a enfermagem no contexto familiar na prevenção de anomalias congênitas. Método: trata-se de uma revisão integrativa da literatura com busca de artigos nas bases de dados Medline, Lilacs, Scielo. Foram incluídos artigos disponíveis na íntegra, online, e gratuitos, publicados entre 2006 a 2017. Artigos de revisão foram desconsiderados, e artigos duplicados foram considerados apenas uma vez. Resultados: a busca inicial resultou em 405 estudos, dos quais 18 foram incluídos nesta revisão. Os artigos selecionados abordam o tema anomalias congênitas com foco no rastreamento e na prevenção. Os achados referiram intervenções de enfermagem a gestante e a família como: consulta de enfermagem, planejamento familiar, educação em saúde a família e a comunidade, acompanhamento por equipe multidisciplinar bem como orientações quanto à suplementação com ácido fólico, exposições a fatores internos e externos, a vacinação preventiva e ao rastreamento genético entre outros. Conclusão: o pré-natal e o planejamento familiar são de suma importância à prevenção e ao rastreamento de anomalias congênitas. A enfermagem pode contribuir com o aconselhamento genético, consultas de enfermagem e apoio emocional e visitas domiciliares no momento do diagnóstico de anomalia congênita e durante a adaptação da família nesse novo contexto. Para isso, a capacitação profissional é indispensável.

Introduction: congenital anomaly is a malformation in the structure or function that are present at birth and during the pre-natal care. It is estimated that every year, 303,000 newborns die within the first four weeks of birth due to congenital anomalies. Objective: Discuss about nursing in the family context in the prevention of congenital anomalies. Method: It is an integrative literature review to search for articles in the databases Medline, Lilacs, Scielo. Articles are available in full online, and toiletries published from 2006 to 2017 were included. Review articles were disregarded, and duplicated articles were considered only once. Results: The initial search resulted in 405 studies, of which 18 were included in this review. The selected articles addressing the topic congenital anomalies with focus on screening and prevention. The findings reported nursing interventions for maternal and family as: nursing consultation, family planning, health education in the family and the community, monitoring by the multidisciplinary team as well as guidelines regarding supplementation with folic acid, exposures to internal and external factors, the preventive vaccination and the genetic screening among others. Conclusion: The prenatal care and family planning are of paramount importance in the prevention and screening for congenital anomalies. Nurses can contribute to the genetic counseling, nursing consultations and emotional support and visits at

Acute disseminated encephalomyelitis, a rare post-malaria neurological complication: Case report and review of the literature.

There are four neurological complications that can occur after malaria treatment at a time when the patient is aparasitaemic: delayed cerebellar ataxia, acute inflammatory demyelinating polyneuropathy, post-malaria neurological syndrome and acute disseminated encephalomyelitis (ADEM). The authors describe a case of a 54-year-old male who presented with encephalopathy and generalized seizures forty-three days after complete recovery from acute malaria by Plasmodium falciparum. Diagnosis of post-malaria ADEM was made based on the acute onset of the neurological symptoms, characteristic findings in magnetic resonance imaging of the brain and prompt response to steroid therapy. ADEM is an autoimmune demyelinating disease of the central nervous system that usually arises after an infection or vaccination. Its occurrence after malaria infection is relatively rare, and to the best of our knowledge there are only thirteen cases described in the literature.

Learning Hepatobiliary Anatomy through the Virtual 3d Anatomy Table / Aprendizado da Anatomia Hepatobiliar pela Mesa Anatômica Virtual 3D

ABSTRACT Objective to evaluate the effectiveness of the 3D virtual anatomical table as a complementary resource to the learning of the hepatobiliary anatomy by undergraduate medical students. Method A randomized controlled study comparing the anatomical learning of hepatobiliary structures, supported by a real model versus a virtual model, both three-dimensional (3D), by undergraduate medical students. The students' perception of the resources used to teach anatomy was also evaluated. The students were submitted to a pre-test and to two evaluations after the interventions were applied. Results Overall, both the 3D virtual anatomical table and the real liver increased students' knowledge of the hepatobiliary anatomy in relation to their previous knowledge (p = 0.001 and p = 0.01, respectively for second and third evaluations). In the longitudinal comparison between the pre-test and the second evaluation (hepatobiliary anatomy and Couinaud's segmentation), this increase was significantly higher in the group allocated to the real liver (p = 0.002); in the comparison of the pre-test with the third evaluation (inclusion of adjacent organs in the anatomical table or in the real liver), the increase in knowledge was significantly higher in the group allocated to the anatomical table (p = 0.04). The perception of participants' satisfaction regarding the learning resources was considered very good, with a minimum percentage of satisfaction of 80%. Conclusion the 3D virtual anatomical table provided more hepatobiliary anatomy knowledge than a real liver for undergraduate medical students, in comparison to their previous knowledge about these structures. In the cross-sectional comparison of the post-instruction evaluations, there was no difference between the two interventions. Moreover, the 3D platform had a positive impact on the level of satisfaction of study participants. This study shows that the 3D virtual anatomical table has the potential to improve both medical students' understanding and interest in anatomy. It is recommended, however, that future protocols such as this be carried out with larger samples and exploring other anatomical structures.

RESUMO Objetivo Avaliar a eficácia da mesa anatômica virtual 3D como recurso complementar ao aprendizado da anatomia hepatobiliar por estudantes de graduação em Medicina. Metodologia Trata-se de estudo randomizado e controlado que comparou a aprendizagem anatômica de estruturas hepatobiliares, apoiada por um modelo real versus por um modelo virtual, ambos tridimensionais (3D), por parte de estudantes de medicina. Avaliou-se também a percepção dos estudantes quanto aos recursos utilizados para o ensino da anatomia. Os alunos foram submetidos a um pré-teste e a duas avaliações após a aplicação das intervenções. Resultados Globalmente, tanto a mesa anatômica virtual 3D quanto o fígado real aumentaram o conhecimento dos estudantes sobre a anatomia hepatobiliar em relação ao conhecimento prévio deles (p = 0,001 e p = 0,01, respectivamente para a segunda e terceira avaliação). Na comparação longitudinal entre o pré-teste e a segunda avaliação (anatomia hepatobiliar e segmentação de Couinaud), esse aumento foi significantemente maior no grupo alocado para o fígado real (p = 0,002); já na comparação do pré-teste com a terceira avaliação (inclusão de órgãos anexos na mesa anatômica ou no fígado real), o aumento do conhecimento foi significantemente maior no grupo alocado para a mesa anatômica (p = 0,04). A percepção de satisfação dos participantes quanto aos recursos de aprendizagem foi considerada muito boa, com percentual mínimo de satisfação de 80%. Conclusão A mesa anatômica virtual 3D forneceu mais conhecimento de anatomia hepatobiliar que um fígado real para estudantes de medicina, em relação ao conhecimento prévio deles sobre essas estruturas. Na comparação transversal das avaliações pós-instrução, não houve diferença entre as duas intervenções. Além disso, a plataforma 3D teve um impacto positivo no nível de satisfação dos participantes do estudo. Este estudo mostra que a mesa anatômica virtual 3D tem potencial para melhorar tanto a compreensão quanto o interesse dos estudantes de medicina pela anatomia. Recomenda-se, no entanto, que futuros protocolos como este sejam realizados com amostras maiores e explorando outras estruturas anatômicas.

Transmissão vertical da sífilis: vivência materna durante a hospitalização para diagnóstico e tratamento de seu filho recém-nascido / Congenital syphilis: maternal experience during the hospitalization for diagnosis and treatment of her infant newborn / Transmisión vertical de sífilis: vivencia materna durante la hospitalización para el diagnóstico y tratamiento de su hijo recién nacido

Introdução: O diagnóstico e tratamento da sífilis congênita requer internação mais prolongada do\r\nrecém-nascido na maternidade, trazendo preocupação e ansiedade materna. Objetivo: Compreender\r\na experiência materna de ter seu fi lho internado para tratamento da sífilis congênita. Método: Estudo\r\ncom desenho qualitativo que adotou a Teoria Fundamentada nos Dados como referencial metodológico.\r\nParticiparam do estudo 11 puérperas cujos fi lhos estavam internados na unidade neonatal de um hospital\r\nescola de São Paulo para tratamento de sífilis congênita. Os dados foram obtidos por meio de entrevista.\r\nResultados: Dois fenômenos emergiram dos dados analisados: "Vivenciando o impacto do diagnóstico\r\nda sífilis" e "Vivenciando a internação do fi lho". Priorizando o tratamento do fi lho acima da minha saúde\r\ne bem-estar é o lema que representa a categoria central da vivência materna. Conclusão: A experiência\r\nmaterna é melhor enfrentada quando a mãe recebe apoio familiar e a abordagem assistencial dos profissionais é isenta de preconceitos e julgamentos.

Introduction: The diagnosis and treatment of congenital syphilis requires more prolonged hospitalization\r\nof the newborn in the maternity ward, causing maternal concern and anxiety. Objective: To understand\r\nthe maternal experience of having her child hospitalized for the treatment of congenital syphilis. Method:\r\nQualitative research by Grounded Theory approach. The study included 11 postpartum women whose\r\nchildren were hospitalized to congenital syphilis treatment at a university hospital neonatal unit, in the\r\ncity of São Paulo, Brazil. Data were collected by interview. Results: Two phenomena emerged from analyzed data: "Living the impact of syphilis diagnosis" and "Experiencing the hospitalization of the child".\r\nPrioritizing the treatment of the child above my health and well-being is the motto that represents the central category of maternal experience. Conclusion: Maternal experience is best faced when the mother\r\nreceives family support and the professional approach is free of prejudices and judgments.

Introducción: El diagnóstico y tratamiento de la sífilis congénita requiere una internación más prolongada\r\ndel recién nacido en la maternidad, trayendo preocupación y ansiedad materna. Objetivo: Comprender\r\nla experiencia materna de tener su hijo internado para el tratamiento de la sífilis congénita. Método: El\r\nestudio adoptó la Teoría Fundamentada en los Datos como referencial metodológico. Participaron del\r\nestudio 11 puérperas cuyos hijos estaban internados en la unidad neonatal de un hospital escuela de\r\nSão Paulo para tratamiento de sífilis congénita. Los datos fueron obtenidos por medio de entrevistas.\r\nResultados: Dos fenómenos emergieron de los datos: "Vivenciando el impacto del diagnóstico de la\r\nsífilis" y "Vivenciando la hospitalización del hijo". Priorizando el tratamiento del hijo por encima de mi\r\nsalud y bienestar es el lema que representa la categoría central de la experiencia materna. La experiencia materna es mejor enfrentada cuando la madre recibe apoyo familiar y el abordaje asistencial de los\r\nprofesionales está exenta de prejuicios y juicios.

Características dos cuidados de enfermagem aos pacientes intubados e traqueostomizados: um relato de experiência / Characteristics of nursing care to patients were intubated and tracheostomized: an experience report

A unidade de terapia intensiva é um local onde se assiste pacientes graves e instáveis, muitas vezes considerados de alta complexidade. Neste local faz-se necessário a assistência de diversos profissionais de saúde, dentre eles a enfermagem. Neste sentido este estudo objetivou relatar os cuidados de enfermagem a pacientes intubados e traqueostomizados observados durante um estágio em unidade de terapia intensiva. Trata-se de um relato de experiência ocorrido em uma Unidade de Terapia Intensiva Cirúrgica de um hospital público da cidade de Goiânia-Goiás, no intuito de descrever os cuidados de enfermagem vivenciados a pacientes intubados e traqueostomizados. Em seguida foram relacionados com os descritos na literatura. Os resultados apontaram que os cuidados de enfermagem eram direcionados para a prevenção de infecções, dentre elas a pneumonia. Esses cuidados se destacaram como aspiração das vias aéreas, higiene oral, monitorização da pressão de cuff, cabeceira elevada em 35º-45º, dentre outros. Assim sendo, a enfermagem é uma das profissões responsáveis por oferecer essa assistência. Conclui-se que, faz necessário, estimular a educação continuada à equipe de enfermagem para que possam sempre estar colocando esses cuidados em pratica, contribuindo para a redução das complicações associadas aos cuidados a saúdes.

The intensive care unit is a place where you watch critically ill patients and unstable, often considered of high complexity. This site makes it necessary the assistance of several health professionals, including nurses. In this sense this study aimed to describe the nursing care of the patients were intubated and tracheostomized observed during an internship in the intensive care unit. It is an experience report occurred in a Surgical Intensive Care Unit of a public hospital in the city of Goiânia, Goiás, in order to describe the nursing care experienced in intubated patients with tracheostomies. Then were related to those described in the literature. The results showed that the nursing care were directed to the prevention of infections, including pneumonia. Such care stood out as aspiration of the airways, oral hygiene, monitoring of the pressure of cuff, head high in 35º-45º, among others. Therefore, nursing is one of the professions responsible for providing such assistance. It is concluded that is necessary to encourage continuing education for nursing staff so they can always be putting such care in practice, contributing to the reduction of complications associated with caring for health.

Métodos qualitativos e quantitativos de avaliação do alinhamento postural / Qualitative and quantitative methods of postural assessment

Introduction: Postural alignment has been studied by health professionals over the years. Due to technological advances, the use of quantitative methods for postural evaluation became more common in clinical practice. Objectives: To present different methods of postural assessment used by health professionals in the last decade. Methods: A literature review in the databases Lilacs, Medline, Pubmed, Cochrane and CAPES from 2000 to 2012 was made, in English, Spanish and Portuguese languages, and the following descriptors were used: posture, evaluation, motor activity, equipment, supplies, avaliación, actividad motora, equipos e suministros. Results: We found 33 papers published in refereed journals, however, only 25 references used qualitative or quantitative instruments for postural evaluation. Conclusion: In the past few years the use of softwares for quantitative postural assessment has been frequently adopted in clinical practice, in addition to the qualitative method. The adoption of these technological tools will allow health professionals to develop more accurate evaluations to determine the magnitude of postural changes. (AU)

Introdução: O alinhamento postural tem sido objeto de estudo de profissionais da saúde ao longo dos anos. Graças aos avanços tecnológicos, o uso de métodos quantitativos para avaliação da postura tem se tornado mais frequente na prática clínica.Objetivos: Apresentar os diferentes métodos de avaliação postural adotados por profissionais da saúde na última década. Métodos: Realizou-se uma revisão de literatura de artigos nas bases de dados Lilacs, Medline, Pubmed, Cochrane e CAPES, no período entre 2000 e 2012, nos idiomas inglês, espanhol e português, utilizando-se os seguintes descritores: postura, avaliação, atividade motora, equipamentos, provisões, posture, evaluation, motor activity, equipment, suplies, avaliación, actividad motora, equipos e suministros. Resultados: Foram encontrados 33 artigos científicos publicados em revistas indexadas, porém somente 25 referências utilizaram instrumentos qualitativos ou quantitativos de avaliação postural. Conclusão: Nos últimos anos o uso de softwares para realização de avaliação postural quantitativa tem se mostrado cada vez mais frequente na prática clínica, como complemento ao método qualitativo. A adoção dessas ferramentas tecnológicas permitirá ao profissional da saúde desenvolver avaliações mais acuradas e determinar a magnitude das alterações posturais. (AU)