Prosocial behavior in children involved in peer violence.

INTRODUCTION: Peer violence is a serious type of school violence that is associated with emotional and behavioral problems. OBJECTIVE: To analyze violence between peers associated with students' social skills. METHODS: We used a cross sectional survey nested in a cluster randomized controlled trial to evaluate peer violence among elementary school students and its association with prosocial behaviors and mental problems. Teachers answered an adapted version of the Revised Olweus Bully/Victim Questionnaire and the Brazilian adaptation of the Teacher Observation of Classroom Adaptation-Checklist (TOCA-C) scale for each student. Children completed a sociodemographic questionnaire. The participants were 1,152 5-14-year-old children from Brazilian public schools; 79.70% reported being involved in violent situations. RESULTS: Children who had both committed and suffered violence were less likely to exhibit prosocial behaviors. Children who committed and suffered violence and those who only committed were more likely to experience concentration problems and disruptive behaviors. DISCUSSION: This study suggests that peer violence is associated with lower prosocial behaviors and more behavioral problems. Thus, more specialized mental health care is required for children involved in peer violence, in addition to the possibility of implementing and maintaining programs to prevent and reduce violence and to develop prosocial behaviors in schools.

The Impact of Family Stress and Resilience on Child Development: a scope review.

INTRODUCTION: Children grow up spending most of their time within the family social environment, where they can experience stressful situations such as marital conflict, a non-cohesive environment, parental alcohol use disorder, parental depression, and other parental mental health issues. All these factors are associated with children's developmental delays. OBJECTIVE: We aimed to conduct a scoping review on family stress and family resilience associated with child development delays to examine familial conditions associated with child development. METHODS: We conducted a scoping review of observational studies published between January 2000 to July 2023, indexed in MEDLINE and LILACS databases. We included observational studies that evaluated the history of exposure to violence, and behavioral or emotional symptoms, or mental health problems among children aged 4-12. Data were independently extracted using a structured form. RESULTS: Database searches identified 12,990 different records. A total of 43 articles were included in the review. Three main findings emerged: (1) parental mental health problems, especially depressive symptoms in mothers, were associated with child developmental delays and mental health problems; (2) better parenting practices and cohesive home environment were positively associated with child development, and (3) Vulnerable social environments (e.g., poverty and housing insecurity) may be linked to child mental health problems. CONCLUSIONS: Studies reviewed show that promoting better family dynamics and increasing family cohesion, as well as parenting abilities, are beneficial to a child's socio-emotional development and prevention of child mental health problems. Moreover, increasing family and children's resilience improves the quality of life within family units.

Targeted anatomical and functional identification of antinociceptive and pronociceptive serotonergic neurons that project to the spinal dorsal horn.

Spinally projecting serotonergic neurons play a key role in controlling pain sensitivity and can either increase or decrease nociception depending on physiological context. It is currently unknown how serotonergic neurons mediate these opposing effects. Utilizing virus-based strategies and Tph2-Cre transgenic mice, we identified two anatomically separated populations of serotonergic hindbrain neurons located in the lateral paragigantocellularis (LPGi) and the medial hindbrain, which respectively innervate the superficial and deep spinal dorsal horn and have contrasting effects on sensory perception. Our tracing experiments revealed that serotonergic neurons of the LPGi were much more susceptible to transduction with spinally injected AAV2retro vectors than medial hindbrain serotonergic neurons. Taking advantage of this difference, we employed intersectional chemogenetic approaches to demonstrate that activation of the LPGi serotonergic projections decreases thermal sensitivity, whereas activation of medial serotonergic neurons increases sensitivity to mechanical von Frey stimulation. Together these results suggest that there are functionally distinct classes of serotonergic hindbrain neurons that differ in their anatomical location in the hindbrain, their postsynaptic targets in the spinal cord, and their impact on nociceptive sensitivity. The LPGi neurons that give rise to rather global and bilateral projections throughout the rostrocaudal extent of the spinal cord appear to be ideally poised to contribute to widespread systemic pain control.

Inhibitory Kcnip2 neurons of the spinal dorsal horn control behavioral sensitivity to environmental cold.

Proper sensing of ambient temperature is of utmost importance for the survival of euthermic animals, including humans. While considerable progress has been made in our understanding of temperature sensors and transduction mechanisms, the higher-order neural circuits processing such information are still only incompletely understood. Using intersectional genetics in combination with circuit tracing and functional neuron manipulation, we identified Kcnip2-expressing inhibitory (Kcnip2GlyT2) interneurons of the mouse spinal dorsal horn as critical elements of a neural circuit that tunes sensitivity to cold. Diphtheria toxin-mediated ablation of these neurons increased cold sensitivity without affecting responses to other somatosensory modalities, while their chemogenetic activation reduced cold and also heat sensitivity. We also show that Kcnip2GlyT2 neurons become activated preferentially upon exposure to cold temperatures and subsequently inhibit spinal nociceptive output neurons that project to the lateral parabrachial nucleus. Our results thus identify a hitherto unknown spinal circuit that tunes cold sensitivity.

Doses of sulfur at topdressing and organic compost supply at planting in the production, quality and content of macronutrients in lettuce seeds

The purpose of this study was to evaluate doses of sulfur applied at topdressing, with and without organic compost supply at planting, in the production, physiological quality and content of macronutrients in lettuce seeds. Ten treatments were evaluated in a 5x2 factorial scheme (five sulfur doses at topdressing x with and without application of organic compost at planting). The experimental design was a randomized block design, with four replicates. The sulfur doses applied at topdressing fertilization were 50, 100, 150 and 200 kg ha-1 of S, in addition to the control treatment (dose zero). Regarding the treatments with organic compost, the dose of 70 t ha-1 of compost (wet basis) was supplied at planting. The following characteristics were evaluated: seed production (mass and number of seeds per plant), seed quality (mass of one thousand seeds, first count of the standard germination test, germination percentage, and germination speed index) and content of macronutrients and mineral accumulation. The organic compost supply at planting increased seed production by 43% compared to the treatment without the application of organic compost, while the doses of sulfur did not affect the production of lettuce seeds. The supply of organic compost increased the accumulation of a great part of the macronutrients, except for the accumulation of calcium. The lettuce seeds quality was not affected by both the main treatments, the sulfur doses at topdressing and the organic compost supply at planting. The descending order of nutrients accumulated in the lettuce seeds was nitrogen> potassium> phosphorus> magnesium> calcium> sulfur.

Construção e validação da escala multifatorial de atração por eventos mórbidos / Construction and Validation of Attraction for Morbid Events Multifactor Scale

Resumo Objetivo. Este estudo buscou construir e validar a Escala Multifatorial de Atração por Eventos Mórbidos (AMAEM). Método. Do primeiro estudo participaram 252 pessoas da população geral, as quais responderam à EMAEM e a perguntas sociodemográficas. A análise de componentes principais indicou uma estrutura de cinco fatores. No segundo estudo, a amostra foi de 609 pessoas da população geral brasileira, as quais a escala de personalidade e a escala de busca de sensações. Resultado. A análise fatorial confirmatória apoaiou a adequação do modelo de cinco fatores. Adicionalmente, demonstrou ainda que os fatores da EMAEM podem contribuir com a compreensão de características da personalidade e sua associação com o engajamento em comportamentos antissociais.

Abstract Objective. This study aimed to construct and validate the Attraction for Morbid Events Multifactor Scale (EMAEM). Method. Two empiric studies were conducted. 252 people from the general population participated in the first study, in which a main component analysis was conducted to attest the factor structure of EMAEM. In this study, the five-factor model was most suitable. In the second study, the participants were 609 people from the general population that answered personality and antisocial behavior scales, besides EMAEM. Results. Confirmatory Factor Analysis shows the suitability of the five-factor model. Moreover, the EMAEM scale can provide aids to a better understanding of personality traits associated with engaging in risky behavior.

Síndromes hipertensivas específicas da gestação provocam desconforto respiratório agudo em recém-nascidos / Hypertensive gestational syndromes cause acute respiratory distress in newborns

Objetivo: Associar as síndromes hipertensivas específicas da gestação (SHEG) com desconforto respiratório agudo em recém-nascidos (RN). Metodologia: Estudo transversal, prospectivo, composto por 130 puérperas com SHEG e 142 RN. Os dados foram coletados através de questionário entre junho e setembro de 2018. Foram utilizados os testes de qui-quadrado de Yates e Exato de Fisher. Resultados: O diagnóstico de SHEG mais prevalente foi pré-eclâmpsia (48,46%). Predominou RN prematuro (62,68%), que necessitou de cuidados intensivos neonatais (61,36%). O diagnóstico de pré-eclâmpsia associou-se a prematuridade (0.01744), baixo peso (0.009306), desconforto respiratório (<0.0000001) e uso de suporte ventilatório (<0.0000001), e de pré-eclâmpsia sobreposta associou-se com desconforto respiratório (0.0006261) e uso de suporte ventilatório (0.0006261). Conclusão: É importante identificar precocemente as SHEG e oferecer uma assistência de qualidade durante o processo gravídico para reduzir os desfechos neonatais desfavoráveis e a taxa de mortalidade infantil. (AU)

Objective: To associate the hypertensive gestational syndromes (SHEG) with acute respiratory distress in newborns (RN). Methods: A prospective, cross-sectional study of 130 puerperal women with SHEG and 142 newborns. Data were collected by means of a questionnaire between June and September 2018. It was used the Yates chi-square test and Fisher's exact test. Results: The most prevalent diagnosis of SHEG was preeclampsia (48,46%). Premature newborns were predominating (62,68%), who needed neonatal intensive care (61,36%). The diagnosis of preeclampsia was associated with prematurity (0.01744), low weight (0.009306), respiratory distress (<0.0000001) and use of ventilatory support (<0.0000001), and overlapping preeclampsia was associated with respiratory distress (0.0006261) and the use of ventilatory support (0.0006261). Conclusion: It is important to identify early SHEG and provide quality care during the pregnancy process to reduce unfavorable neonatal outcomes and the infant mortality rate. (AU)

Objetivo: Asociar los síndromes hipertensivos específicos del embarazo (SHEG) con la dificultad respiratoria aguda en recién nacidos (RN). Metodos: Estudio transversal, prospectivo, compuesto por 130 puérperas con SHEG y 142 recién nacidos. Los datos fueron recolectados a través de un cuestionario entre junio y septiembre de 2018. Se utilizó las pruebas de chi cuadrado de Yates y Exacto de Fisher. Resultados: El diagnóstico de SHEG más prevalente fue preeclampsia (48,46%). Predominó recién nacidos prematuro (62,68%), que necesitó de cuidados intensivos neonatales (61,36%). El diagnóstico de preeclampsia se asoció a la prematuridad (0.01744), bajo peso (0.009306), dificultad respiratoria (<0.0000001) y uso de soporte ventilatorio (<0.0000001), y el de preeclampsia superpuesta se asoció con dificultad respiratoria (0.0006261) y uso de soporte ventilatorio (0.0006261). Conclusión: Es importante identificar precozmente el SHEG y ofrecer una asistencia de calidad durante el proceso gravídico para reducir los resultados neonatales desfavorables y la tasa de mortalidad infantil. (AU)

Chemophenetics as a Tool for Distinguishing Morphotypes of Annona emarginata (Schltdl.) H. Rainer.

Annona emarginata (Annonaceae) has two morphological variations (A. emarginata 'mirim' and A. emarginata 'terra-fria'). The species has agricultural value and produces specialized metabolites of pharmacological interest. The objective of this work was to analyze whether chemical and morphological differences contribute to differentiate A. emarginata 'terra-fria' from A. emarginata 'mirim', as chemophenetic variations of A. emarginata. The analysis of chemical compounds was based on the quantification, profile of root alkaloids and on the leaves volatile profile, together with morphometric analyses of the leaf blade. The samples were collected in three phenological stages (flowering, fruiting, and vegetative) at two places in São Paulo, Brazil. Differences in the composition of the alkaloid profile and leaf volatiles (in both places and in the three phenological stages) allowed us to separate the two morphotypes by multivariate statistical analysis. These differences agreed with the leaf blade morphology and flower color. This first chemophenetic report of A. emarginata demonstrates that, in addition to morphological variations, the specialized metabolism of roots and leaves can be phytochemical characters, which suggest the existence of at least morphochemotypes of A. emarginata.

Parteiras Tradicionais: conhecimentos compartilhados, práticas e cuidado em saúde / Traditional midwives: shared knowledge, practices and health care

Este livro sobre Parteiras Tradicionais: conhecimentos compartilhados, práticas e cuidados com a saúde foi cuidadosamente concebido e organizado com o propósito de contribuir para o reconhecimento social e político das práticas e dos saberes daquelas (e, daqueles em bem menor número) que, através de gerações acompanham e assistem as mulheres em momentos da sua gestação, parição e pós-parto, em especial, àquelas cuja morada se situa em áreas distantes dos circuitos de atendimento dos serviços públicos de saúde.

Shift of µ-opioid Receptor Signaling in the Dorsal Reticular Nucleus Is Implicated in Morphine-induced Hyperalgesia in Male Rats.

BACKGROUND: Increased descending pain facilitation accounts for opioid-induced hyperalgesia, but the underlying mechanisms remain elusive. Given the role of µ-opioid receptors in opioid-induced hyperalgesia in animals, the authors hypothesized that the dorsal reticular nucleus, a medullary pain facilitatory area, is involved in opioid-induced hyperalgesia through altered µ-opioid receptor signaling. METHODS: The authors used male Wistar rats (n = 5 to 8 per group), chronically infused with morphine, to evaluate in the dorsal reticular nucleus the expressions of the µ-opioid receptor and phosphorylated cAMP response element-binding, a downstream marker of excitatory µ-opioid receptor signaling. The authors used pharmacologic and gene-mediated approaches. Nociceptive behaviors were evaluated by the von Frey and hot-plates tests. RESULTS: Lidocaine fully reversed mechanical and thermal hypersensitivity induced by chronic morphine. Morphine-infusion increased µ-opioid receptor, without concomitant messenger RNA changes, and phosphorylated cAMP response element-binding levels at the dorsal reticular nucleus. µ-opioid receptor knockdown in morphine-infused animals attenuated the decrease of mechanical thresholds and heat-evoked withdrawal latencies compared with the control vector (von Frey [mean ± SD]: -17 ± 8% vs. -40 ± 9.0%; P < 0.001; hot-plate: -10 ± 5% vs. -32 ± 10%; P = 0.001). µ-opioid receptor knockdown in control animals induced the opposite (von Frey: -31 ± 8% vs. -17 ± 8%; P = 0.053; hotplate: -24 ± 6% vs. -3 ± 10%; P = 0.001). The µ-opioid receptor agonist (D-ALA2,N-ME-PHE4,GLY5-OL)-enkephalin acetate (DAMGO) decreased mechanical thresholds and did not affect heat-evoked withdrawal latencies in morphine-infused animals. In control animals, DAMGO increased both mechanical thresholds and heat-evoked withdrawal latencies. Ultra-low-dose naloxone, which prevents the excitatory signaling of the µ-opioid receptor, administered alone, attenuated mechanical and thermal hypersensitivities, and coadministered with DAMGO, restored DAMGO analgesic effects and decreased phosphorylated cAMP response element-binding levels. CONCLUSIONS: Chronic morphine shifted µ-opioid receptor signaling from inhibitory to excitatory at the dorsal reticular nucleus, likely enhancing descending facilitation during opioid-induced hyperalgesia in the rat.

Retrospective clinical and epidemiological analysis of scorpionism at a referral hospital for the treatment of accidents by venomous animals in Alagoas State, Northeast Brazil, 2007-2017.

Scorpionism has a high incidence rate in Brazil. It is considered a serious public health problem mainly in tropical and subtropical regions around the world. The number of scorpion accidents have increased over the years and the highest frequencies have been reported mainly in the Brazilian Northeast region. Therefore, in this study we report a retrospective clinical and epidemiological analysis of scorpion stings from 2007 to 2017 in Alagoas State, Northeast Brazil, at a referral hospital for assistance and treatment of accidents by venomous animals. During the analyzed period, the referral hospital treated 27,988 cases, and an increase in the number of cases has taken place over the years. The highest frequency of scorpion stings was observed in females, and the age range most affected was from 20 to 29 years old. The most stung body site was the foot, followed by finger, toe or hand. Regarding the severity, most severe cases were reported in children up to 4 years old (69.4%) and 50% of the total cases treated with serotherapy corresponded to patients in this age range. Interestingly, it was also found that the occurrence of systemic manifestations and the severity of the cases were significantly associated with pediatric patients. In this way, this study highlights the scorpionism as an environmental public health problem in Alagoas State, Northeast Brazil, as well as the need to intensify the epidemiological surveillance and educational campaigns to prevent and control scorpion accidents throughout the year.

As parteiras tradicionais e a medicalização do parto na região rural do Amazonas / Traditional midwives and medicalization of childbirth in a rural area of Amazonas / Las parteras y la medicalización del parto en la región rural de Amazonas

Resumo Em comunidades rurais da Amazônia o saber partejar faz parte do domínio de algumas mulheres. No entanto, a ampliação do acesso à Saúde Pública aumentou a medicalização do parto, o que ressignifica o papel das parteiras. Este trabalho discute o papel das parteiras nesse contexto, as práticas e as técnicas tradicionais em uma região do Amazonas. O aprendizado do partejar acontece na adolescência e na juventude, as jovens são iniciadas no ofício acompanhando as parteiras mais velhas. Constatamos também que as parteiras exercem importante papel na decisão sobre o encaminhamento das mulheres para o parto nos hospitais das cidades, além do acompanhamento durante a gravidez, às vezes parto e puerpério. Dessa forma, continuam fazendo parte da rede de pessoas que se dedicam aos cuidados com o parto, na qual mais recentemente passaram a interagir práticas tradicionais e conhecimentos médico-científicos.

Abstract In rural Amazonian communities, midwifery is still part of some women's knowledge. However, the expansion of access to the public health system has increased the medicalization of childbirth, which re-signified the role of midwives. This paper discusses the role of midwives in this context, their traditional practices and techniques. Midwifery learning happened in adolescence and youth, young women were initiated in the practice while accompanying older midwives. We also found that midwives play an important role in decisionmaking about referral of pregnant women to deliver their babies in city hospitals, in addition they also play an important role during pregnancy, and sometimes in the delivery and puerperium. Therefore, they continue to be part of the network of caregivers, where more recently there has been interaction between traditional practices and scientific medical knowledge.

Resumen En comunidades rurales de la Amazonía saber atender partos forma parte del dominio de algunas mujeres. Sin embargo, la ampliación del acceso a la Salud Pública en la Amazonia aumentó la medicalización del parto, lo que resignificó el papel de las parteras. Este trabajo discute la partería en ese contexto, sus prácticas y técnicas tradicionales en una región del Amazonas. El aprendizaje de la partería se produjo en la adolescencia y la juventud, las jóvenes se iniciaron en el oficio acompañando a las parteras más viejas. También constatamos que las parteras ejercen un importante papel en la decisión sobre el encaminamiento de las mujeres para el parto en los hospitales de las ciudades, además del acompañamiento durante el embarazo, a veces parto y puerperio. De esta forma, continúan formando parte de la red de personas que se dedican a los cuidados con el parto, donde más recientemente pasaron a interactuar prácticas tradicionales y conocimientos médicos científicos.

Sífilis gestacional: fatores associados, comportamento de risco e repercussões neonatais / Gestational syphilis: associated factors, risk behavior and neonatal repercussions

Objetivo: analisar o comportamento de risco, os fatores associados e as repercussões neonatais em gestantes com sífilis. Método: estudo transversal, descritivo e retrospectivo, composto por 107 casos de sífilis gestacional em um hospital referência em gestação de alto risco, no período entre janeiro de 2016 e abril de 2017. Para análise estatística, foram aplicados os testes de qui-quadrado de Yates e Exato de Fisher. Resultados: maior ocorrência em mulheres jovens (56,1%), de cor não branca (81%), sem companheiro (53%), procedentes de outros municípios (65%), com menor escolaridade (62%) e sem exercer atividade remunerada (82%). Apesar de realizarem o pré-natal (95%), obtiveram um tratamento inadequado para a infecção (60%) e sem adesão dos parceiros sexuais (48%). Houve um predomínio de recém-nascidos pré-termos (51%), classificados com baixo peso ao nascer (35%) e vivos (90%). Houve uma associação estatisticamente significante entre o comportamento de risco com a escolaridade de até 8 anos de estudos (p<0.010), número de consultas de pré-natal <6 (p<0.001) e ocorrência de parto vaginal (p<0.032). Conclusão: as desigualdades sociais, aliadas às falhas na assistência pré-natal, corroboram para a persistência do quadro epidemiológico de sífilis no Brasil

Objective: to analyze the risk behavior, associated factors and neonatal repercussions in pregnant women with syphilis. Method: a cross-sectional, descriptive and retrospective study of 107 cases of gestational syphilis in a high-risk gestational hospital, in the period between January 2016 and April 2017. For statistical analysis, the chi-square Yates and Fisher's Exact test were applied. Results: greater occurrence in young women (56.1%), non-white skin color (81%), without companion (53%), coming from other municipalities (65%), lower schooling (62%) and without exercising paid activity (82%). Although they performed prenatal care (95%), they were inadequately treated for infection (60%) and without adherence of sexual partners (48%). There was a predominance of preterm newborns (51%), classified as having low birth weight (35%) and alive (90%). There was a statistically significant association between risk behavior with up to 8 years of schooling (p <0.010), number of prenatal consultations <6 (p <0.001), and vaginal delivery (p <0.032). Conclusion: social inequalities, together with failures in prenatal care, corroborate the persistence of the epidemiological presentation of syphilis in Brazil

Queixas de nutrizes que buscam atendimento em um banco de leite humano e fatores associados / Complaints from nursing mothers seeking care in a human milk bank and associated factors

O objetivo deste artigo é analisar as queixas de nutrizes que buscaram atendimento em um BLH e fatores associados. Trata-se de um estudo descritivo, analítico, transversal, retrospectivo, cuja população é composta por 1.709 nutrizes que buscaram atendimento no período de Janeiro a Dezembro de 2016. Para a coleta de dados, utilizaram-se as fichas de atendimento do BLH. As principais queixas que levaram as nutrizes a buscarem atendimento no BLH relacionam-se à dificuldade com a técnica de amamentação (41,9%) e a problemas mamários, como o ingurgitamento mamário (27,1%) e o trauma mamilar (18,1%). A necessidade de auxílio na técnica de amamentação esteve associada às seguintes condições relativas à nutriz: ser procedente da capital (p=0,001), apresentar mais de oito anos de estudo (p=0,040), ter uma ocupação (p=0,010), ser primípara (p=<0,001), optar pela realização de parto cesárea (p=<0,001) e ter experiência prévia com amamentação (p=0,004). Houve associação entre ingurgitamento mamário e primiparidade (p=0,038), além do fato de a nutriz ter contado com o apoio ao aleitamento materno na maternidade (p=0,021). O estudo possibilitou verificar a importância dos BLH no processo de lactação, um período em que as mulheres ficam ansiosas, necessitam de informações confiáveis e apresentam muitas queixas em relação à lactação

The aim of this article is to analyze the complaints of lactating mothers who sought care in a HMB and associated factors. It is a descriptive, cross-sectional, retrospective study, whose population is composed of 1.709 lactating mothers who sought care in the period from January to December the 2016. For the data collection, were used the service records of the HMB. The main complaints that led the lactating mothers to seek care at HMB were related to the difficulty with the breastfeeding technique (41.9%) and to breast problems, such as breast engorgement (27.1%) and nipple trauma (18,1%). The need for breastfeeding technique was associated to the following nutrient conditions: coming from the capital (p = 0.001), presenting more than eight years of study (p = 0.040), having an occupation (p = 0.010), being primiparous (p = <0.001), opt for cesarean (p = 0.001) and to have previous experience with breastfeeding (p = 0.004). There was an association between breast engorgement and primiparity (p = 0.038), in addition to the fact that the mother had support for breastfeeding in the maternity ward (p = 0.021). The study made it possible to verify the importance of HMBs in the lactation process, a period in which women become anxious, require reliable information and have many complaints about lactation

Contribuições da Enfermagem obstétrica para as boas práticas no trabalho de parto e parto vaginal / Contributions of the obstetrical Nursing for the good practices in labor and vaginal delivery

Objetivo: analisar as contribuições da enfermagem obstétrica para as boas práticas no trabalho de parto e parto vaginal. Metodologia: estudo transversal, quantitativo, retrospectivo, envolvendo 475 prontuários de mulheres com gestação de risco habitual, do estado de Goiás, no período de janeiro a dezembro de 2016. Análise com testes de qui-quadrado de Yates e Exato de Fisher. Resultados: houve associação entre os partos sem os enfermeiros residentes em obstétrica e a não utilização dos métodos não farmacológicos para alívio da dor (p<0.0000001), não utilização do partograma (p<0.0000001), ausência de acompanhante no parto (p<0.0000001), clampeamento precoce do cordão umbilical (p=0.00004323), e a privação da amamentação na primeira hora (p=0.0001509). Já os partos assistidos por enfermeiros residentes em obstetrícia associaram-se à não realização da episiotomia (p<0.0000001). Conclusão: enfatiza-se a importância da atuação da Enfermagem Obstétrica no parto para garantir assistência humanizada e boas práticas. (AU)

Objective: To analyze the contributions of the obstetrical nursing for the good practices in labor and vaginal delivery. Methodology: A cross-sectional, quantitative and retrospective study involving 475 medical records of women with normal risk pregnancies, in Goias State, during the period from January to December of 2016. Analysis using Yates chi square test and Fisher's Exact test. Results: There was an association between the labors without the obstetric nursing residents and the non-se of non-pharmacological methods for providing pain relief (p<0.0000001), non-use of partograph (p<0.0000001), absence of companionship during labour (p<0.0000001), early clamping of the umbilical cord (p=0.00004323), and to the deprivation of breastfeeding in the first hour (p=0.0001509). The deliveries assisted by obstetric nursing residents were associated to the non-performance of the episiotomy (p<0.0000001). Conclusion: Emphasis is placed on the importance of obstetric nursing work in childbirth to ensure humanized care and good practices. (AU)

Objetivo: Analizar las contribuciones de la enfermería obstétrica para las buenas prácticas en el trabajo de parto y parto vaginal. Metodología: Estudio transversal, cuantitativo, retrospectivo, involucrando 475 prontuarios de mujeres con gestación de riesgo habitual, del Estado de Goiás, en el período de enero a diciembre de 2016. Análisis con pruebas de chi-cuadrado de Yates y Exacto de Fisher. Resultados: Se observó asociación entre los partos sin los enfermeros residentes en obstétrica y la no utilización de los métodos no farmacológicos para alivio del dolor (p<0.0000001), no utilización del partograma (p<0.0000001), ausencia de acompañante en el parto (p<0.0000001), pinzamiento precoz del cordón umbilical (p=0.00004323), y la privación de la lactancia en la primera hora (p=0.0001509). Los partos asistidos por enfermeros residentes en obstetricia se asociaron a la no realización de la episiotomía (p<0.0000001). Conclusión: Se enfatiza la importancia de la actuación de la enfermería obstétrica en el parto para garantizar asistencia humanizada y buenas prácticas. (AU)

Caracterização dos casos notificados de zika vírus em gestantes em um hospital da região centro-oeste / Characterization of the reported cases of zika virus in pregnant women in a hospital in the midwest brazil region

Objetivo: Caracterizar o perfil das gestantes notificadas para Zika Vírus (ZIKV) em um hospital da região Centro-Oeste. Metodologia: Estudo transversal, descritivo, quantitativo e retrospectivo, composto por 311 casos suspeitos de ZIKV em gestantes atendidas em um Hospital Público de referência no período dezembro de 2015 a dezembro de 2017. Análise com teste de qui-quadrado e Exato de Fisher. Resultados: Foram confirmados 180 (58%) casos, predominou mulheres com idade entre 19-35 anos 250 (61%), residente em Goiânia 126 (70%). Houve associação estatisticamente significante em relação aos casos confirmados em gestantes na faixa etária de 19 a 35 anos (p<0.0071), ocorrência de casos durante o segundo semestre de 2015 (p<0.0028), e o primeiro semestre de 2016 (p<0.0000001). Conclusão: Mediante o agravo que a infecção pelo ZIKV pode ocasionar durante a gestação, é imprescindível que os casos suspeitos sejam monitorados. (AU)

Objective: To characterize the profile of pregnant women reported for Zika Virus (ZIKV) in a hospital in the Midwest. Methodology: A cross-sectional, descriptive, quantitative and retrospective study of 311 suspected ZIKV cases in pregnant women attending a Reference Public Hospital during the period of December 2015 to December 2017. Analysis using chi-square test and Fisher's exact test. Results: 180 (58%) cases were confirmed, predominantly women aged between 19-35 years 250 (80%), living in Goiânia 126 (70%). There was a statistically significant association with confirmed cases in pregnant women aged 19-35 years (p<0.0071), occurrence of cases during the second half of 2015 (p<0.0028), and the first half of 2016 (p<0.0000001). Conclusion: Due to the complications that infection by ZIKV can cause during pregnancy, it is necessary that the suspected cases are monitored. (AU)

Objetivo: Caracterizar el perfil de las mujeres embarazadas notificadas para Zika Virus (ZIKV) en un hospital de la región Centro-Oeste. Metodología: Estudio transversal, descriptivo, cuantitativo y retrospectivo, compuesto por 311 casos sospechosos de ZIKV en mujeres embarazadas atendidas en un Hospital Público de referencia en el período de diciembre de 2015 a diciembre de 2017. Análisis con prueba de chi-cuadrado y Exacto de Fisher. Resultados: Se confirmaron 180 (58%) casos, predominó mujeres con edad entre 19-35 años 250 (80%), residentes en Goiânia 126 (70%). Se observó asociación estadísticamente significativa en relación a los casos confirmados en mujeres embarazadas en el grupo de edad de 19 a 35 años (p<0.0071), ocurrencia de casos durante el segundo semestre de 2015 (p<0.0028), y el primer semestre de 2016 (p<0.0000001). Conclusión: Mediante las complicaciones que la infección por el ZIKV puede ocasionar durante la gestación, es imprescindible que los casos sospechosos sean monitoreados. (AU)

Gestantes que recebem informações de profissionais de saúde conhecem seus direitos no período gravídico-puerperal / Pregnant women who receive information from health professionals and are made aware of their rights in the pregnancy-puerperal period

Objetivo: Associar a aquisição de conhecimento de gestantes sobre os direitos no período gravídico-puerperal com recebimento de informações por profissionais de saúde. Metodologia: Estudo transversal, descritivo, quantitativo, prospectivo, composto por 88 gestantes, no período de maio a agosto de 2018. Análise com teste de Qui-quadrado e Exato de Fisher. Resultados: Houve associação quanto quem recebeu informação e acertou sobre o período de licença maternidade (p=0.005722), sobre o direito de abono de falta no trabalho mediante apresentação do atestado médico e comparecimento (p=0.007903), e a lei do acompanhante (p=0.005869). Houve associação de quem não recebeu informação e errou sobre o direito de realizar no mínimo 6 consultas e demais exames complementares no horário de trabalho (p=0.02705). Conclusão: É de suma importância que as gestantes recebam orientações sobre os direitos por parte dos profissionais de saúde e exijam seu cumprimento, melhorando sua assistência obstétrica. (AU)

Objective: To associate the pregnant women ́s knowledge regarding their rights in the pregnancy-puerperal period with the information received from health professionals. Methodology: A cross-sectional, descriptive, quantitative and prospective study, composed by 88 pregnant women, during the period of May to August of 2018. Analysis using chi square test and Fisher's Exact test. Results: An association of those who received information was found with those who got the right period of maternity leave (p=0.005722), in relation to the right to paid time off upon presentation of the medical certificate (p=0.007903), and the law of companionship (p=0.005869). There was an association of those who did not receive information and missed about their right of carrying out at least 6 doctor appointments and other complementary examinations during working hours (p=0.02705). Conclusion: It is extremely important that pregnant women receive guidance on their rights from health professionals, enforcing them and improving their obstetric care. (AU)

Objetivo: Asociar la adquisición de conocimiento de las mujeres embarazadas sobre los derechos en el período gravídico-puerperal con el recibimiento de informaciones por profesionales de salud. Metodología: Estudio transversal, descriptivo, cuantitativo, prospectivo, compuesto por 88 gestantes, en el período de mayo a agosto de 2018. Análisis con prueba de Chi-cuadrado y Exacto de Fisher. Resultados: Se observó asociación de quien recibió información y acertó sobre el período de licencia maternidad (p=0.005722), sobre el derecho de inasistencia al trabajo mediante la presentación del certificado médico (p=0.007903), y la ley del acompañante (p=0.005869). Se observó asociación de quien no recibió información y se equivocó sobre el derecho de realizar por lo menos 6 consultas y demás exámenes complementarios en el horario de trabajo (p=0.02705). Conclusión: Es de suma importancia que las mujeres embarazadas reciban orientaciones sobre los derechos por parte de los profesionales de salud y exijan su cumplimiento, mejorando su asistencia obstétrica. (AU)

Nem santa, nem pecadora: novas roupagens, velhas dicotomias na coisificação da mulher / Neither saint nor sinner: new outlooks, old dichotomies in the reification of women

Resumo: Analisamos o movimento histórico de dominação da mulher no capitalismo, entendendo que as relações sociais de sexo e gênero são responsáveis pelos altos índices de violência contra as mulheres, uma das múltiplas expressões da questão social. A coisificação do corpo feminino reforçado pela mídia é acompanhada pela ideia da liberdade sexual, uma forma de aproximação da mulher ao seu corpo e sexualidade, mas que tende a ser utilizada como reafirmação do corpo feminino como coisa a ser consumida.

Abstract: We analyze the historical movement of female domination in capitalism, understanding that the social relations of sex and gender are responsible for the high rates of violence against women, one of the multiple expressions of the social question. The reification of the female body reinforced by the media is accompanied by the idea of sexual freedom, a way of approaching the woman to her body and sexuality, but which tends to be used as a reaffirmation of the female body as an object to be consumed.

Desafios e perspectivas de mães de crianças com microcefalia pelo vírus Zika / Challenges and perspectives of mothers of children with microcephaly due to Zika virus infection

Objetivo: compreender desafios e perspectivas de mães de crianças com microcefalia pelo vírus Zika. Métodos: estudo qualitativo, realizado com doze mães de crianças com microcefalia pelo vírus Zika, em hospital público pediátrico. Dados coletados por meio de entrevista semiestruturada, os quais foram submetidos à análise de conteúdo. Resultados: de acordo com as falas, as mães, em maioria, desconheciam a ocorrência de vírus Zika na gestação, sendo o momento do diagnóstico caracterizado por surpresa e sofrimento, apesar da superação observada. Muitas delas não sabiam o significado de microcefalia, bem como desconheciam as alterações e limitações que as crianças poderiam apresentar. Ao descrever as dificuldades no cuidado com o filho, revelaram que usavam a espiritualidade como forma de enfrentamento. Conclusão: a microcefalia trouxe, de tal forma, nova realidade para as mulheres investigadas, que, por vezes, negavam a própria realidade, demonstrando, nas falas, muitos desafios e poucas perspectivas. (AU)

Epidemia do virus Zika: a mais nova emergência internacional / Zika virus epidemic: the newest international emergency

A infecção pelo vírus Zika é uma doença relativamente nova, com publicações limitadas a relatos de casos e investigações de surtos. Inicialmente foi descrita antes de 2007 na África e Ásia, posteriormente na Polinésia Francesa no Pacífico e, por fim, nas Américas, em 2015. O Brasil confirmou o primeiro caso de infecção pelo vírus Zika em março de 2015(1) e, desde outubro, tem registrado aumento explosivo do número de recém-nascidos com microcefalia e também aumento de condições neurológicas, incluindo a síndrome de Guillain-Barré. A forte suspeita de a infecção pelo vírus Zika estar relacionada a essas manifestações é que levaram o Comitê de Emergência de Saúde Pública da Organização Mundial de Saúde declarar, no dia 1º de fevereiro deste ano, que a propagação do vírus é um problema emergencial de saúde pública internacional, ou seja, um evento extraordinário, grave, inesperado e que, potencialmente, requer uma ação internacional coordenada(2-3). A ausência de outra explicação para o aumento dramático de casos de microcefalia e da síndrome de Guillain-Barré, ambos concentrados em áreas recém-infectadas pelo vírus Zika, apoiam a recomendação de medidas agressivas para evitar/reduzir a infecção com o vírus Zika, especialmente entre mulheres grávidas e as em idade fértil. No mesmo documento, a Organização Mundial de Saúde recomenda vigilância de casos de microcefalia e da síndrome de Guillain-Barré nas áreas de risco e pesquisas etiológicas desses eventos para determinar se a infecção pelo vírus Zika é causal e se há outros fatores de risco associados. As medidas de precauções adicionais são:(i)relacionadas à transmissão do vírus: vigilância epidemiológica, controle de vetor, medidas de proteção, informação e aconselhamento às mulheres grávidas e às que desejam engravidar; (ii)medidas de longo prazo: investimento em pesquisas voltadas para produção de vacina, diagnóstico acurado e tratamento, capacitação para cuidados com síndromes neurológicas e malformações congênitas; (iii)medidas para viajantes: aconselhamento, desinfestação de aeronaves e deaeroportos e; (iv)compartilhamento de informações. Alguns questionamentos têm sido feitos sobre a magnitude desta epidemia e a associação com microcefalia/desordens neurológicas(4-5). É razoável ponderar que exista histórico sub-registro de microcefalia no Sistema de Informações de Nascidos Vivos do Brasil. Também é esperado que após o alerta nacional, o número de casos suspeitos se eleve. Ou seja, o aumento ou a implementação de vigilância sempre resulta em maior sensibilidade de detecção de casos suspeitos/notificados, com aumento de falso-positivos. Por essas razões, é possível dizer que parte do aumento nos casos de microcefalia notificados pode ser atribuível à intensa vigilância. O que é inimaginável é que a prevalência de microcefalia no nordeste brasileiro seja 10-20 vezes maior que a de outros países(6). No momento, existem hipóteses que o vírus Zika possa ter papel etiológico e/ou fisiopatológico para esses eventos, usualmente raros. O que nos parece inquestionável, é a gravidade da situação. Gestores de saúde não podem esperar evidências científicas de alto nível. Calma e prudência para avaliar é aconselhável. Evitar conclusões prematuras, idem. Entretanto, diante da potencial ameaça, temos o dever de, pelo menos, proteger as mulheres grávidas e seus fetos. A situação atual nos coloca muitos desafios a enfrentar, e parece lógico que o Brasil protagonize o início das ações. Reconhecemos em nossa história tanto o sucesso no combate à febre amarela no início do século passado como nossa recente ineficiência no combate ao mosquito Aedes aegypti para o controle da dengue e da chikungunya. É preciso criar, renovar e fortalecer estratégias de controle e de proteção efetivas. O que temos de novo para vislumbrar melhor desfecho? Esforço internacional e financiamento de pesquisas para melhor combate ao vírus Zika e mobilização da população e dos profissionais de saúde frente à gravidade das doenças por ele provocadas e suas sequelas. Dificuldades? Muitas, sem dúvida. Além das dificuldades de controle do vetor já conhecidas no enfrentamento da dengue, circulam no Brasil outros mosquitos do gênero Aedes capazes de atuarem como vetores do vírus Zika(7-8), criando novas possibilidades de transmissão e disseminação da infecção. Porém, é clara a emergência de ações para, no mínimo, reduzir o impacto e o receio das malformações congênitas nas futuras gerações. O combate sem trégua ao mosquito deve ser o foco principal das nossas ações e isso implica em revermos nossas atitudes enquanto cidadãos. Não há espaço para o mero expectador. A batalha já iniciou e será longa! É chegada a hora de agir! É chegada a hora de toda a nação se mobilizar! É hora de mobilizar todo o país!

Infection from the Zika virus is a relatively new disease with limited publications reporting cases and research on outbreaks. It was initially described before 2007 in Africa and Asia, then later in the French Polynesia in the Pacific, and finally in the Americas, in 2015. Brazil confirmed its first case of infection from the Zika virus in March 2015(1) and since October 2015 it has recorded an explosive growth in the number of babies born with microcephaly and also an increase inneurological conditions, including Guillain-Barré syndrome. The strong suspicion that the infection from the Zika virus is related to these manifestations is what brought the Public Health Emergency Committee of the World Health Organization to declare on February 1st of 2016 that the spread of the virus is an emergency international public health problem, meaning that it is a serious, unexpected extraordinary event that could potentially require a coordinated international action(2-3). The absence of another explanation for the dramatic increase in cases of microcephaly and the Guillain-Barré syndrome, both concentrated in areas newly infected by the Zika virus, supports the recommendation of aggressive measures to prevent and reduce infection with the Zika virus, especially among pregnant women and those of reproductive age. In the same document, the World Health Organization recommends monitoring cases of microcephaly and the Guillain-Barré syndrome in the areas of risk and etiological studies of these events to determine whether infection by the Zika virus is causal and if there are other risk factors associated. Measures of additional precautions are as follows: (i)Related to the transmission of the virus: epidemiological surveillance, vector control, protection measures, information and counseling for pregnant women and to those who wish to get pregnant. (ii)Long-term measures: investment in research for vaccine production, accurate diagnosis and treatment, training for caring for neurological syndromes and congenital malformations. (iii)Measures for travelers: counseling, disinfestation of aircrafts and airports. (iv)Sharing of information. Some inquiries have been made about the magnitude of this epidemic and its association with microcephaly and neurological disorders(4-5). It is reasonable to consider that there is an underreporting of microcephaly in the records of the Live Births Information System in Brazil. It is also to be expected that, after the national alert, the number of suspected cases would rise. When there is an increase or the implementation of surveillance, this always results in higher sensitivity of detection of suspected/reported cases with an increase in false positives. For these reasons, it is possible to say that part of the increase in reported cases of microcephaly may be attributable to the current intense surveillance. What is inconceivable, however, is that the prevalence of microcephaly in northeastern Brazil is 10 to 20 times higher than in other countries(6). At present, there are hypotheses that the Zika virus may have an etiologic and/or pathophysiological role for these events, which is usually rare. What seems indisputable is the gravity of the situation. Health managers cannot wait for high-level scientific evidence. Care and prudence when assessing is advisable, and the same goes for avoiding premature conclusions. However, given the potential threat, we have a duty to at least protect pregnant women and their fetuses. The current situation poses many challenges that we need to face and it seems logical that Brazil take the lead in beginning the actions. We recognize in our history both the success in the fight against yellow fever early in the last century and also our recent inefficiency in the fight against the Aedes aegypti mosquito to control dengue and chikungunya. It is necessary to create, renew, and strengthen our control strategies for an effective protection. What do we have that is new to envision a better outcome? An international effort, funding for research to better fight the Zika virus, and mobilization of the population and health professionals considering the severity of the disease it causes and its consequences. Difficulties? Many, no doubt. In addition to the vector control difficulties already known in fighting dengue, other mosquitos of the genus Aedes circulating in Brazil can act as vectors of the Zika virus(7-8), which creates new possibilities for transmitting and spreading the infection. However, the need for emergency actions is clear, at least to reduce the impact and the fear of congenital malformations in future generations. A relentless fight against the mosquito should be the main focus of our actions and this implies in reviewing our attitudes as citizens. There is no room for mere spectators. The battle has begun and it will be a long one! It is time to act! It is time for the nation to work together! It is time to call the entire country to action!