Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: Results from the IMAgiNE EURO study.

OBJECTIVE: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. METHODS: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. RESULTS: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). CONCLUSION: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.

Individual and country-level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region.

OBJECTIVE: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. METHODS: Online anonymous survey of women who gave birth in 2020-2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. RESULTS: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P < 0.001). Country-level variables contributed to explaining some of the variance between countries. CONCLUSION: We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care.

Quality of maternal and newborn care around the time of childbirth for migrant versus nonmigrant women during the COVID-19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region.

OBJECTIVE: To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. METHODS: Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. RESULTS: Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. CONCLUSION: Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.

WHO Standards-based questionnaire to measure health workers' perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries.

OBJECTIVES: Develop and validate a WHO Standards-based online questionnaire to measure the quality of maternal and newborn care (QMNC) around the time of childbirth from the health workers' perspective. DESIGN: Mixed-methods study. SETTING: Six countries of the WHO European Region. PARTICIPANTS AND METHODS: The questionnaire is based on lessons learnt in previous studies, and was developed in three sequential phases: (1) WHO Quality Measures were prioritised and content, construct and face validity were assessed through a Delphi involving a multidisciplinary board of experts from 11 countries of the WHO European Region; (2) translation/back translation of the English version was conducted following The Professional Society for Health Economics and Outcomes Research guidelines; (3) internal consistency, intrarater reliability and acceptability were assessed among 600 health workers in six countries. RESULTS: The questionnaire included 40 items based on WHO Standards Quality Measures, equally divided into four domains: provision of care, experience of care, availability of human and physical resources, organisational changes due to COVID-19; and its organised in six sections. It was translated/back translated in 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. The Cronbach's alpha values were ≥0.70 for each questionnaire section where questions were hypothesised to be interrelated, indicating good internal consistence. Cohen K or Gwet's AC1 values were ≥0.60, suggesting good intrarater reliability, except for one question. Acceptability was good with only 1.70% of health workers requesting minimal changes in question wording. CONCLUSIONS: Findings suggest that the questionnaire has good content, construct, face validity, internal consistency, intrarater reliability and acceptability in six countries of the WHO European Region. Future studies may further explore the questionnaire's use in other countries, and how to translate evidence generated by this tool into policies to improve the QMNC. TRAIL REGISTRATION NUMBER: NCT04847336.

Hypertriglyceridemic waist phenotype and associated factors in individuals with arterial hypertension and/or diabetes mellitus.

Cardiovascular diseases are among the main causes of death in Brazil and worldwide. The literature indicates the hypertriglyceridemic waist phenotype (HTWP) as an accessible alternative for the identification of cardiovascular and metabolic risk. The present study aimed to identify the prevalence and factors associated with HTWP in individuals diagnosed with arterial hypertension (AH) and/or diabetes mellitus type 2 (DM2). A cross-sectional study was conducted with individuals diagnosed with AH and/or DM2. The study data were collected through semi-structured interviews containing socio-demographic information, lifestyle, health care, in addition to anthropometric assessment, blood pressure measurement and biochemical blood tests. The prevalence of HTWP was estimated and bivariate and multivariate logistic regression was used to assess the factors associated with HTWP. Of the 788 individuals analysed, 21⋅5 % had the HTWP. In the adjusted model, the following variables remained associated with a greater chance of presenting HTWP: sex, age, body mass index (BMI) and very-low-density lipoprotein (VLDL). Being female increased the chance of HTWP by 7⋅7 times (OR 7⋅7; 95 % CI 3⋅9, 15⋅2). The one-year increase in age increased the chance of HTWP by 4 % (OR 1⋅04; 95 % CI 1⋅02, 1⋅06). The addition of 1 mg/dl of VLDL-c increased the chance of HTWP by 15 % (odds ratio (OR) 1⋅15; 95 % confidence interval (CI) 1⋅12, 1⋅18), as well as the increase of 1 kg/m2 in the BMI increased the chance of this condition by 20 % (OR 1⋅20; 95 % CI 1⋅15, 1⋅27). The prevalence of HTWP was associated with females, older age, higher BMI, higher VLDL-c and risk waist/height ratio.

Low-grade albuminuria in adult and elderly individuals with diabetes mellitus and arterial hypertension accompanied by Primary Health Care.

Diabetes mellitus (DM) and arterial hypertension (AH) are the two main clinical conditions related to Chronic Kidney Disease (CKD); disease also identify by the levels of low-grade albuminuria (LGA). Few studies have simultaneously investigated the associations of glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) with LGA. Our study aimed to investigate and compare the association of HbA1c and FPG with the probability of LGA in adult and elderly individuals with DM and AH, within the scope of Primary Health Care (PHC). Cross-sectional study involving 737 Brazilians individuals previously diagnosed with hypertension and/or diabetes. Tests for HbA1c, FPG and LGA were performed. LGA was defined as the highest quartile of albumin urinary (≥ 13 mg/g) among individuals with urinary LGA < 30 mg / g. A significant increase in the prevalence of LGA was found with increasing levels of HbA1c (p < 0.001). There was a significant association of HbA1c with LGA (p < 0.001) and increased probability of LGA for participants with HbA1c ≥ 6.5% compared to those with Hba1c < 5.7% (OR [95% CI]: 2.43 [1.32-4.46], p < 0.05), after adjusting for confounding factors, except when adjusted for FPG (p = 0.379 and p = 0.359, respectively). HbA1c and FPG were significantly associated in a collinear manner with an increased probability of LGA in adult and elderly individuals with DM and AH.

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort.

BACKGROUND: optimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority. METHODS: we performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox's proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values. RESULTS: Data from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39-5.12), serum iron (HR = 8.396, 95% CI: 2.02-34.96), serum calcium (HR = 4.102, 95% CI: 1.35-12.46) and serum protein (HR = 4.630, 95% CI: 2.07-10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01-0.74), high ferritin values (HR = 0.392, 95% CI: 0.19-0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19-0.61) and serum albumin (HR = 0.230, 95% CI: 0.10-0.54) were less risk to die. CONCLUSION: survival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

Individual and Combined Components of Metabolic Syndrome with Chronic Kidney Disease in Individuals with Hypertension and/or Diabetes Mellitus Accompanied by Primary Health Care.

PURPOSE: To identify the associations between MetS and its components and chronic kidney disease (CKD) in a population with arterial hypertension (AH), or diabetes mellitus (DM) accompanied by the Primary Health Care (PHC). PATIENTS AND METHODS: A cross-sectional study with 788 individuals diagnosed with AH and/or DM followed by PHC of Viçosa, Brazil. Anthropometric, biochemical and clinical measures were performed for the diagnosis of MetS and CKD. MetS was identified using the NCEP-ATPIII criteria. CKD was identified by estimating the glomerular filtration rate using the CKD-EPI equation. Logistic regression models were used to estimate the chances of CKD associated with MetS and its components and specific combinations of components. RESULTS: The prevalence of MetS reported in the population was 65.4%, that of hidden CKD was 15.4%. The prevalence of CKD among participants with MetS was 75.2%. The most prevalent component of MetS in the population was AH (96.7%). Elevated fasting blood glucose, central obesity, and reduced HDL-c were significantly associated with an increased chance of CKD (OR = 2.80, 95% CI 1.76-4.45, OR = 1.68, 95% CI, 05-2.71, OR = 1.61, CI 95% 1.03-2.50, respectively). For the multivariate adjustment, the participants with MetS were 2 times more likely to have CKD than those without MetS (OR = 2.07; 95% CI, 1.25-3.44). The combination of three components of MetS high blood pressure, abdominal obesity and elevated fasting blood glucose and the combination of four components of MetS high blood pressure, reduced HDL-c, high fasting blood glucose and abdominal obesity were associated with increased odds of CKD (OR = 2.67, CI 95% 1.70-4.20, OR = 2.50, CI 95% 1.55-4.02, respectively). CONCLUSION: MetS, as well as its individual or combined components were independently associated with CKD in the population with AH and/or DM accompanied by PHC.

Prevalence of chronic kidney disease in Brazilians with arterial hypertension and/or diabetes mellitus.

The present study aimed to evaluate the prevalence of chronic kidney disease (CKD) in individuals with arterial hypertension (AH) and/or diabetes mellitus (DM) accompanied by Primary Health Care (PHC) in Brazil. The estimated glomerular filtration rate (eGFR) based on creatinine, and urinary albumin-to-creatinine ratio (ACR) were measured in 841 subjects with AH and/or DM, followed by PHC in the city of Viçosa. The CKD was diagnosed according to KDIGO criteria. Sociodemographic, clinical, and anthropometric factors related to the prevalence of CKD were investigated through multiple logistic regression. The prevalence of hidden CKD was 15.4%. Of these, 7.5% were identified by albuminuria (ACR ≥30 mg/g) with slightly decreased eGFR. Age, baseline disease, waist circumference (WC), and systolic blood pressure remained associated with CKD after multivariate analysis. The two major risk factors for hidden CKD were the presence of AH in association with DM and an increase in age. Hidden CKD was more common within people with AH and DM, and with high WC, glycosylated hemoglobin, and serum phosphorus as well as male gender and decreased serum albumin. This knowledge of risk associations can help avoid progression to CKD.

Violência laboral: percepções de professores quanto às medidas de enfrentamento / Work violence: teachers 'perceptions in relation to coping measures

Objetivo: conhecer a percepção dos professores dos Ensinos Fundamental e Médio sobre as medidas para se evitar a violência em salas de aula. Método: trata-se de um estudo qualitativo, descritivo, com docentes dos Ensinos Fundamental e Médio de duas escolas da rede pública. Coletaram-se os dados por meio de entrevistas em áudio gravadas, e, para a análise, adotou-se a técnica de Análise de Conteúdo na modalidade Análise Temática. Resultados: registra-se que a maioria dos docentes era do sexo feminino (n=24; 77,42%) e estava na faixa etária dos 31 aos 40 anos de idade (35,48%). Revela-se, em relação à escolaridade (54,84%), que tinham titulação de especialista Lato sensu. Constituiu-se, a partir das falas, uma categoria temática, << Percebendo as formas de proteção contra a violência sofrida pelo professor >>, subdividida por cinco subcategorias. Conclusão: percebeu-se que as medidas para a diminuição da violência na percepção dos professores incluem a legislação rigorosa e a punição dos agressores, a diminuição do número de alunos nas salas de aula, a valorização do trabalho docente e as redes de apoio ao professor, a presença de profissionais de segurança no âmbito escolar, a criação de espaços de diálogos e o apoio de psicólogos.(AU)

Objective: to know the perception of teachers of elementary and high schools about measures to avoid violence in classrooms. Method: this is a qualitative, descriptive study, with teachers from elementary and high schools in two public schools. Data was collected through recorded audio interviews, and for the analysis, the Content Analysis technique was adopted in the Thematic Analysis modality. Results: it is registered that the majority of teachers were female (n = 24; 77.42%) and were in the age group from 31 to 40 years old (35.48%). It is revealed, in relation to education (54.84%), that they had the title of specialist Lato sensu. Based on the speeches, a thematic category was constituted, << Perceiving the forms of protection against the violence suffered by the teacher >>, subdivided into five subcategories. Conclusion: it was noticed that measures to reduce violence in the perception of teachers include strict legislation and the punishment of aggressors, the decrease in the number of students in classrooms, the appreciation of teaching work and teacher support networks , the presence of security professionals in the school environment, the creation of spaces for dialogues and the support of psychologists.(AU)

Objetivo: conocer la percepción de los docentes de las escuelas primarias y secundarias sobre las medidas para evitar la violencia en las aulas de clase. Método: este es un estudio cualitativo, descriptivo, con maestros de escuelas primarias y secundarias en dos escuelas públicas. Los datos se recopilaron a través de entrevistas de audio grabadas, y para el análisis, se adoptó la técnica de Análisis de Contenido en la modalidad de Análisis Temático. Resultados: se registra que la mayoría de los docentes eran mujeres (n = 24; 77.42%) y pertenecían al grupo de edad de 31 a 40 años (35.48%). Se revela, en relación con la educación (54.84%), que tenían el título de especialista Lato sensu. Sobre la base de los discursos, se constituyó una categoría temática, <>, subdividida en cinco subcategorías. Conclusión: se observó que las medidas para reducir la violencia en la percepción de los docentes incluyen una legislación estricta y el castigo de los agresores, la disminución del número de estudiantes en las aulas, la apreciación del trabajo docente y las redes de apoyo docente, la presencia de profesionales de la seguridad en el entorno escolar, la creación de espacios de diálogo y el apoyo de psicólogos.(AU)

Fatores de satisfações e insatisfações no trabalho de enfermeiros / Satisfaction and dissatisfaction factors in the work of nurses

Objetivo: identificar os fatores que motivam a satisfação e insatisfação no trabalho de enfermeiros. Método: trata-se de um estudo qualitativo, descritivo, com 15 enfermeiros de um pronto-socorro de um hospital de universitário. Coletaram-se os dados por meio de entrevistas individuais audiogravadas e se utilizou a Técnica de Análise de Conteúdo na modalidade Análise Temática. Resultados: emergiram-se após análise duas categorias: << Fatores que motivam a insatisfação no trabalho >> e << Fatores que motivam a satisfação no trabalho >>. Relacionou-se a insatisfação ao número insuficiente de recursos humanos e materiais e à falta de valorização da sociedade do enfermeiro; já a satisfação esteve associada com a oportunidade de capacitação e as reuniões do serviço. Conclusão: precisam-se programar estratégias que proporcionem maximizar as vivências de satisfação e minimizar a insatisfação, o que repercutirá em uma melhor qualidade de assistência aos pacientes, familiares e na promoção da saúde do trabalhador.(AU)

Objective: to identify the factors that motivates nurses' job satisfaction and dissatisfaction. Method: this is a qualitative, descriptive study, with 15 nurses from an emergency room at a university hospital. Data was collected through individual audio-recorded interviews and the Content Analysis Technique was used in the Thematic Analysis modality. Results: two categories emerged after analysis: << Factors that motivate job dissatisfaction >> and << Factors that motivate job satisfaction >>. Dissatisfaction was related to the insufficient number of human and material resources and the lack of appreciation of the nurse's society; satisfaction was associated with training opportunities and service meetings. Conclusion: strategies need to be programmed to maximize the experiences of satisfaction and minimize dissatisfaction, which will result in a better quality of care for patients, family members and the promotion of workers' health.(AU)

Objetivo: identificar los factores que motivan la satisfacción e insatisfacción laboral de los enfermeros. Método: este es un estudio cualitativo, descriptivo, con 15 enfermeros de una sala de emergencias en un hospital universitario. Los datos se recopilaron a través de entrevistas individuales grabadas en audio y la Técnica de Análisis de Contenido se utilizó en la modalidad de Análisis Temático. Resultados: surgieron dos categorías después del análisis: << Factores que motivan la insatisfacción laboral >> y << Factores que motivan la satisfacción laboral >>. La insatisfacción se relacionó con la cantidad insuficiente de recursos humanos y materiales y la falta de apreciación de la sociedad del enfermero; la satisfacción se asoció con oportunidades de capacitación y reuniones de servicio. Conclusión: las estrategias deben programarse para maximizar las experiencias de satisfacción y minimizar la insatisfacción, lo que dará como resultado una mejor calidad de atención para los pacientes, los familiares y la promoción de la salud de los trabajadores.(AU)

Applying best practices to pregnant women in the obstetric center.

OBJECTIVE: To identify the meaning attributed by nursing technicians to good care practices based on scientific evidence used with the pregnant women during the dilation stage of labor. METHOD: A qualitative study, based on Grounded Theory principles. Twelve interviews with nursing technicians attending labor in the obstetric center of two public hospitals, in Florianópolis/SC, were performed, from August of 2016 to March of 2017. Data were analyzed using open, axial coding. RESULTS: The implementation of good practices, for nursing technicians, means adequately performing their activities, providing humanized care to the pregnant woman, respecting her autonomy, promoting pain relief, and a peaceful labor. FINAL CONSIDERATIONS: An adequate number of technicians must be determined to maintain quality of care, and to complete nursing records in a more detailed and systematized manner.

Applying best practices to pregnant women in the obstetric center / Buenas prácticas aplicadas a las parturientes en el centro obstétrico / Boas práticas aplicadas às parturientes no centro obstétrico

ABSTRACT Objective: To identify the meaning attributed by nursing technicians to good care practices based on scientific evidence used with the pregnant women during the dilation stage of labor. Method: A qualitative study, based on Grounded Theory principles. Twelve interviews with nursing technicians attending labor in the obstetric center of two public hospitals, in Florianópolis/SC, were performed, from August of 2016 to March of 2017. Data were analyzed using open, axial coding. Results: The implementation of good practices, for nursing technicians, means adequately performing their activities, providing humanized care to the pregnant woman, respecting her autonomy, promoting pain relief, and a peaceful labor. Final Considerations: An adequate number of technicians must be determined to maintain quality of care, and to complete nursing records in a more detailed and systematized manner.

RESUMEN Objetivo: Identificar el significado que los técnicos de enfermería atribuyen a las buenas prácticas de cuidado basadas en evidencias científicas aplicadas a las parturientas durante la fase de dilatación del trabajo de parto. Método: Estudio cualitativo, basado en los principios de Grounded Theory. Se realizaron 12 entrevistas con técnicas de enfermería que asistieron a parturientas en trabajo de parto en el centro obstétrico de dos hospitales públicos de Florianópolis/SC, de agosto de 2016 a marzo de 2017. Los datos se analizaron a través de la codificación abierta y axial. Resultados: Para las técnicas de enfermería, aplicar las buenas prácticas significa desempeñar su función de forma adecuada, proporcionar asistencia humanizada a la parturienta, respetando su autonomía, promover alivio del dolor y un trabajo de parto más tranquilo. Consideraciones finales: Se recomienda la identificación del número adecuado de técnicos para el mantenimiento de la calidad de la asistencia y la realización de registros de enfermería de forma más detallada y sistematizada

RESUMO Objetivo: Identificar o significado que técnicos de enfermagem atribuem às boas práticas de cuidado baseadas em evidências científicas aplicadas às parturientes durante a fase de dilatação do trabalho de parto. Método: Estudo qualitativo, fundamentado nos princípios da Grounded Theory. Realizou-se 12 entrevistas com técnicas de enfermagem que assistiam parturientes em trabalho de parto no centro obstétrico de dois hospitais públicos de Florianópolis/SC, de agosto 2016 à março 2017. Os dados foram analisados através da codificação aberta e axial. Resultados: Para as técnicas de enfermagem a realização das boas práticas significa desempenhar sua função de forma adequada, proporcionar assistência humanizada à parturiente, respeitando sua autonomia, promover alívio da dor e um trabalho de parto mais tranquilo. Considerações Finais: recomenda-se a identificação do número adequado de técnicos para a manutenção da qualidade da assistência e a realização de registros de enfermagem de forma mais detalhada e sistematizada.

Associating portal congestive gastropathy and hepatic fibrosis in hepatosplenic mansoni schistosomiasis.

Upper digestive bleeding is one of the most serious complications of mansoni schistosomiasis, and portal congestive gastropathy (PCG) is responsible for 25-30% of the cases of bleeding instead of bleeding due to esophageal varices. This study aimed to investigate the association between PCG with parameters of portal hypertension and the intensity of periportal fibrosis assessed by ultrasonography, in patients with mansoni schistosomiasis. A prospective study was made of 71 patients whether or not they had a history of upper digestive bleeding, and who had not been previously treated for portal hypertension (splenectomy, use of beta blockers or endoscopic treatment). Patients with other liver diseases were excluded. After signing a form of consent, the patients underwent endoscopy, as well as ultrasonography of the abdomen, and hematological, biochemical and viral markers tests. Chi-square and Fischer's exact tests were used in the statistical analysis. The mean age of the 71 patients was 50 ± 14.5 years of whom 59.2% were women. 45.1% had antecedents of upper digestive bleeding. PCG was observed in 39 patients (54.9%): severe in 8.5%, and mild in 46.5%. A positive association was observed between PCG and the grade of esophageal varices (p=0.017); and the pattern of periportal fibrosis (p=0.041). A negative association was observed between PCG and red spots on the varices (p=0.024). PCG in patients with mansoni schistosomiasis not submitted to treatment for portal hypertension is associated with the sonographic pattern of hepatic fibrosis, as well as with the grade of esophageal varices.

Olhares e saberes: vivências de puérperas e equipe de enfermagem frente à dor pós-cesariana / Looks and knowledge: experiences of mothers and nursing staff regarding post-caesarean section pain / Miradas y conocimiento: experiencias de las madres y el personal de enfermería con respecto a dolor post cesárea

Trata-se de uma pesquisa exploratório-descritiva que teve por objetivo identificar a percepção, o conhecimento e ações da puérpera e da equipe de enfermagem frente à dor pós-cesariana. Os dados foram coletados através de entrevistas semiestruturadas realizadas no mês de maio de 2011 com 40 puérperas submetidas à cesariana, no Alojamento Conjunto da Maternidade de um hospital-escola de Florianópolis-SC, Brasil, e também com 22 membros da equipe de enfermagem que prestou assistência às puérperas. A análise dos dados foi realizada de acordo com a proposta do Discurso do Sujeito Coletivo. Os resultados evidenciam que a dor pós-cesariana é uma realidade vivenciada pela totalidade das puérperas a ela submetidas, apesar de não ser unanimidade entre os profissionais de enfermagem e apontam para a necessidade de investir-se na qualificação profissional no âmbito do manejo da dor, tanto em nível de formação, quanto em nível de atualização.

The aim of this exploratory-descriptive study was to identify the perceptions, knowledge and actions of postpartum women and nursing staff regarding pain after cesarean section. Data were collected through semi-structured interviews, conducted in May 2011 with 40 postpartum women who underwent a cesarean section, at the Rooming-In unit of a maternity at a teaching hospital in Florianópolis-SC, Brazil, and also with 22 nursing team members who attended the postpartum women. Data were analyzed in accordance with the Collective Subject Discourse proposal. The results show that pain after cesarean delivery is a reality all mothers who undergo this delivery method experience, although the nursing professionals are not anonymous about it, indicating the need to invest in professional qualification on pain management, including training and recycling.

Se trata de un estudio exploratorio-descriptivo. Tuvo como objetivo identificar las percepciones, conocimientos y acciones del post-parto y el personal de enfermería en relación con el dolor después de una cesárea. Los datos fueron recolectados a través de entrevistas semi-estructuradas realizadas en el mes de mayo de 2011, con 40 mujeres sometidas a cesárea post-parto, en el alojamiento conjunto de una maternidad en un hospital- escuela de Florianópolis-SC, Brasil y también con 22 miembros del personal de enfermería que proporcionaban asistencia a las madres. El análisis de los datos se realizó de acuerdo con la propuesta del Discurso del Sujeto Colectivo. Los resultados muestran que el dolor después de una cesárea es una realidad que enfrentan todas las madres que se refiere a ella, aunque no la unanimidad entre las enfermeras, e indican la necesidad de invertir en la capacitación en el manejo del dolor, tanto en el nivel de formación y actualización.

Contaminação bacteriana e fúngica de canudos de refrigerantes e seus recipientes em lanchonetes de município do interior de São Paulo / Fungal and bacterial contamination of drinking straws and their containers in snack bars in a municipality of São Paulo state, Brazil

OBJETIVO: Avaliar o nível de contaminação bacteriana e fúngica de canudos de refrigerantes e seus recipientes em 30 lanchonetes do Município de Ibiúna (SP), correlacionando com as condições de higiene, processos e métodos de desinfecção destes estabelecimentos. MÉTODOS: Foram colhidas três amostras por estabelecimento nas embalagens fechadas, em recipientes e swab em toda a superfície de contato. Foi aplicado um questionário a fim de avaliar: a empresa fornecedora dos canudos, higienização, freqüência e desinfecção, e foram efetuadas inspeções sanitárias nos estabelecimentos. Para as análises microbiológicas foi utilizada a técnica de lavagem superficial e semeadura em meios, para contagem de bactérias mesófilas. As amostras turvas foram semeadas em meios de cultura para: Staphylococcus aureus, Bacillus cereus, Pseudomonas aeruginosa, Enterococcus, coliformes totais e/ou termotolerantes. RESULTADOS: Dentre os microorganismos isolados nas amostras dos canudos nos recipientes foi detectado Bacillus cereus em 36,6 por cento, Enterococo spp. em 3,3 por cento. O Bacillus cereus foi isolado em 46,6 por cento nos swabs dos recipientes, e em 13,3 por cento, Enterococos. Na análise de associação do nível de contaminação microbiana de canudos de refrigerantes e seus recipientes com as condições de higiene, os processos de higienização e a desinfecção dos estabelecimentos, não foi identifica significância estatística (p>0,05). CONCLUSÃO: O Bacillus cereus foi o microorganismo que prevaleceu nas embalagens íntegras dos canudos, nos seus recipientes e no swab das superfícies. Não foi comprovada a associação de fatores de risco de contaminação bacteriana e fúngica.

OBJECTIVE: The objective of this study was to evaluate the fungal and bacterial contamination level of drinking straws and their containers of thirty snack bars at the municipality of Ibiuna (SP, Brazil) and to correlate these data with conditions of hygiene and the processes and methods of disinfection of these establishments. METHODS: Three samples of closed packages, containers and contact surface swabs were collected in each establishment. A questionnaire was administered to identify the straws supplier, hygiene methods, frequency and disinfection. Sanitary inspections were also performed in these establishments. Microbiological analyses were done using the superficial washing technique and seeding plates to count mesophilic bacteria, mold and yeasts. Turbid samples were seeded in culture media for: Staphylococcus aureus, Bacillus cereus, Pseudomonas aeruginosa, Enterococcus, total and/or thermotolerant coliforms. RESULTS: Microorganisms isolated from samples of drinking straws were Bacillus cereus 36.6 percent, Enterococcus spp and Molds/yeasts 3.3 percent. Swabs of containers revealed 46.6 percent of Bacillus cereus and 13.3 percent of Enterococcus. Association analyses of the microbial contamination level of drinking straws and their containers with conditions of hygiene, hygiene processes and disinfection of the establishments did not show statistical significance (p>0.05). CONCLUSION: Bacillus cereus was the most prevalent microorganism in closed packages, containers and surface swabs. No statistical association of risk factors for bacterial or fungal contamination was found.

Análise físico-química e bacteriológica do leite cru e pasteurizado do Banco de Leite Humano de Sorocaba, SP / Physicochemical analysis and bacteriological of the pasteurized of the Human Milk Bank of Sorocaba, SP

Banco de Leite Humano (BLH) é o serviço responsável pela promoção e incentivo ao aleitamento materno, que atende às necessidades nutricionais de recém-nascidos prematuros ou de baixo peso. Sua matéria prima é o leite materno, alimento único que possui componentes bioquímicos, celulares e nutricionais ideais para o desenvolvimento destes. Deve fornecer um produto perfeitamente processado e com qualidade garantida antes de sua distribuição. Para controlar o processamento do leite do BLH de Sorocaba, são realizados análises físico-químicas e microbiológicas no Instituto Adolfo Lutz - Laboratório Regional de Sorocaba. Durante o período pesquisado, a acidez foi determinada em 1.858 amostras de leite cru, o valor calórico calculado em 1.457 amostras e a presença de coliformes totais e termotolerantes pesquisada em 3.883 amostras de leite pasteurizado. O resultados obtidos mostraram que o índice de acidez acima de 8 graus Dornic foi responsável por 24,1 por cento das amostras de leite rejeitadas pelo BLH de Sorocaba, enquanto que apenas 2,6 por cento o foram por presença de contaminação bacteriana. A técnica do crematócrito permitiu classificar as amostras de leite em três faixas calóricas. A análise de rejeição das amostras de leite indicou a necessidade de reorientação das doadoras na etapa de coleta do leite humano ordenhado, visto que a alta incidência de amostras com acidez elevada pode ser devida às condições higiênico-sanitárias no momento da ordenha.

Hypertensive portal colopathy in schistosomiasis mansoni--proposal for a classification.

Portal hypertension is a frequent complication of chronic liver disease, detected not only in schistosomiasis, but also in cirrhosis of any etiology. Vascular alterations in the colonic mucosa are a potential source for acute or chronic bleeding and have been observed in patients with portal hypertension. The purpose of this prospective study was to describe and propose a classification for the vascular alterations of portal hypertension in the colonic mucosa among patients with hepatosplenic schistosomiasis mansoni. One or more alterations of portal colopathy were observed in all patients and they were classified according to their intensity, obeying the classification proposed by the authors. Portal colopathy is an important finding in hepatosplenic schistosomiasis and might be the cause of lower gastrointestinal bleeding in patients with severe portal hypertension.

Hypertensive portal colopathy in schistosomiasis mansoni: proposal for a classification

Portal hypertension is a frequent complication of chronic liver disease, detected not only in schistosomiasis, but also in cirrhosis of any etiology. Vascular alterations in the colonic mucosa are a potential source for acute or chronic bleeding and have been observed in patients with portal hypertension. The purpose of this prospective study was to describe and propose a classification for the vascular alterations of portal hypertension in the colonic mucosa among patients with hepatosplenic schistosomiasis mansoni. One or more alterations of portal colopathy were observed in all patients and they were classified according to their intensity, obeying the classification proposed by the authors. Portal colopathy is an important finding in hepatosplenic schistosomiasis and might be the cause of lower gastrointestinal bleeding in patients with severe portal hypertension.

O "des"cuidado em saúde: a violência no processo de trabalho em enfermagem / The care (lessness) in the nursing work with chemical dependents

Este estudo tratou-se de pesquisa convergente-assistencial1, objetivando identificar formas de violência presentes no cuidado institucionalizado à saúde, segundo percepções e experiências de trabalhadoras de Enfermagem, discutindo as questões éticas e educativas envolvendo violência no processo de trabalho de Enfermagem. Através de questionários e oficinas educativas, privilegiando expressões das participantes, identificou-se diferentes nuanças e classificações acerca de violência. A análise dos dados permitiu o entendimento sobre significados expressos pelas trabalhadoras quanto à violência na vida social e no cotidiano de trabalho, evidenciando o reconhecimento de duas faces do objeto: trabalhador de Enfermagem enquanto agente de violência e, paralelamente, receptor da violência. Constataram-se diversas formas a partir das quais a violência se manifesta e é apreendida pelos sujeitos, assim como os limites e a busca de soluções para enfrentamento desta realidade de (des)cuidado, contribuindo para ação-reflexão com vistas a um trabalho/cuidado humanizado, ético e cidadão...

A convergent-assistance research1 was conducted, to identify forms of violence existing in the institutionalized health care according to perception and experiences of Nursing workers. Ethic and educative questions are debated, involving violence in the work process of Nursing. By means of questionnaires and educative workshops, employing expressions of the subjects, different tonalities and classifications of violence were identified. Data analysis made possible to grasp meanings expressed by the staff on the violence in social life and work daily routine, making clear the two faces of the object: Nursing worker as an agent of and, parallel to that, as the receiver of violence. Various forms were detected from which violence springs up and is apprehended by the subjects, as well as the limits and the search for solutions to face the reality of carelessness, contributing to the action-reflection regarding a humane work/care, one which is ethic and turned to the citizen...

Este estudio tuvo como objetivo identificar las formas de violencia presentes en el cuidado institucionalizado de salud, a partir de las percepciones y experiencias de trabajadoras de Enfermería. Se trata de una investigación convergente-asistencial1, desarrollada con trabajadoras de Enfermería que privilegió las expresiones de las participantes colocadas a través de la aplicación de un cuestionario, en el contexto del día a día en el cuidado para la salud y del trabajo de Enfermería. El análisis de los datos permitió un entendimiento sobre los significados expresados por las trabajadoras estudiadas en lo que respecta a violencia en la vida social y en su día a día durante el trabajo, evidenciando el trabajador de Enfermería como agente de violencia y, de otro lado, este mismo trabajador como receptor de la violencia. Este estudio contribuyó para la acción-reflexión de la profesión de Enfermería con miras a un proceso de trabajo / cuidado humanizado, ético y ciudadano y, sobre todo, para repensar la Enfermería y la vida...