Nutritional Knowledge about Maternal and Newborn Health among Physiotherapists during the COVID-19 Pandemic in Minas Gerais, Brazil.

Adequate nutrition before and during pregnancy, as well as postpartum, is among the major contributors to maternal and newborn health. Physiotherapists' knowledge of this area is still scarce, although their clinical practice has been linked to newborns' neuropsychomotor development, which, in turn, is influenced by maternal health and nutritional status. Therefore, this study aimed to evaluate the nutritional knowledge of physiotherapists regarding maternal and newborn health. A total of 70 Brazilian physiotherapists (32.2 ± 6.0 years; 72.9% females) were evaluated between November 2019 and February 2020 for their sociodemographic characteristics, professional experience, and nutritional knowledge about maternal and newborn health through a validated questionnaire personally administered by the same trained researcher. Most of the physiotherapists had graduated but had no specialization in maternal and child physiotherapy (96.1% of the females and all the males). The nutritional knowledge about maternal and newborn health was significantly different between the female and male health professionals, as well as between the less and more experienced participants, i.e., female physiotherapists and the more experienced ones had more correct answers on the nutritional questionnaire than the male and less experienced physiotherapists, respectively (p < 0.05). Our results open an interesting window for the future education and training of Brazilian physiotherapists in nutrition.

The (temporary) Covid-19 baby bust in Mexico.

In this paper, we investigate whether fertility and newborn health changed during the Covid-19 pandemic in Mexico. We use national administrative data and an event-study design to examine the impact of the Covid-19 pandemic on fertility and newborn health characteristics. Our findings suggest that Mexico's fertility declined temporarily as measured by conceptions that likely occurred during the stay-at-home order. Initially, the general fertility rate fell by 11-12 per cent but quickly rebounded and returned close to its original levels by the end of 2021. Newborn health also deteriorated during the pandemic. Instances of low birthweight and prematurity substantially increased, with both remaining elevated over the entire pandemic period.

Provider Perceptions on Bereavement Following Newborn Death: A Qualitative Study from Ethiopia and Ghana.

OBJECTIVE: The objective of this study was to explore how clinicians in low- and middle-income countries engage and support parents following newborn death. STUDY DESIGN: Qualitative interviews of 40 neonatal clinicians with diverse training were conducted in Addis Ababa, Ethiopia, and Kumasi, Ghana. Transcribed interviews were analyzed and coded through the constant comparative method. RESULTS: Three discrete themes around bereavement communication emerged. (1) Concern for the degree of grief experienced by mothers and apprehension to further contribute to it. This led to modified communication to shield her from emotional trauma. (2) Acknowledgment of cultural factors impacting neonatal loss. Clinicians reported that loss of a newborn is viewed differently than loss of an older child and is associated with a diminished degree of public grief; however, despite cultural expectations dictating private grief, interview subjects noted that mothers do suffer emotional pain when a newborn dies. (3) Barriers impeding communication and psychosocial support for families, often relating to language differences and resource limitations. CONCLUSIONS: Neonatal mortality remains the leading global cause of mortality under age 5, with the majority of these deaths occurring in low- and middle-income countries, yet scant literature exists on approaches to communication around end-of-life and bereavement care for neonates in these settings. We found that medical providers in Ghana and Ethiopia described structural and cultural challenges that they navigate following the death of a newborn when communicating and supporting bereaved parents.

Transmídia na enfermagem pediátrica para orientações aos familiares no enfrentamento da COVID-19: relato de experiência / Transmedia en enfermería pediátrica para orientación a familiares en el enfrentamiento al COVID-19: relato de experiencia / Transmedia in pediatric nursing for guidance to family members in coping with COVID-19: experience report

Objetivo: descrever a experiência da transmídia na enfermagem pediátrica para orientações aos familiares sobre os cuidados aos recém-nascidos e às crianças no enfrentamento da covid-19. Método: relato de experiência sistematizado em cinco tempos (ponto de partida, perguntas iniciais, recuperação do processo vivido, reflexão de fundo e pontos de chegada), oriundo de um projeto de iniciação tecnológica, com dados do período de agosto 2021/junho 2022, sobre a publicação de conteúdos transmidiáticos, referentes aos cuidados na infância em tempos de covid-19, tendo como público-alvo os familiares de recém-nascidos e crianças. Resultados: conteúdos foram criados e publicados em diversas mídias sociais (Instagram, Facebook, Spotify, Youtube e WhatsApp), permitindo durante a pandemia, o compartilhamento, de forma convergente, de orientações científicas fidedignas e confiáveis. Conclusão: a transmídia na enfermagem pediátrica mostrou-se inovadora, dinâmica e proveitosa, além de baixo custo e grande potencial de abrangência.

Objective: to describe the experience of transmedia in pediatric nursing for guidance to family members on care for newborns and children in coping with covid-19. Method: experience report systematized in five stages (starting point, initial questions, recovery of the lived process, background reflection and points of arrival), from a technological initiation project, with data from the period of August 2021/June 2022, on the publication of transmedia content, referring to childhood care in times of covid-19, with the target audience being family members of newborns and children. Results: content was created and published on several social media (Instagram, Facebook, Spotify, Youtube and WhatsApp), allowing during the pandemic the convergent sharing of reliable scientific guidelines. Conclusion: transmedia in pediatric nursing proved to be innovative, dynamic and profitable, in addition to low cost and great potential for coverage.

Objetivo: describir la experiencia de transmedia en enfermería pediátrica para orientar a los familiares sobre el cuidado del recién nacido y del niño en el enfrentamiento al covid-19. Método: relato de experiencia sistematizado en cinco etapas (punto de partida, preguntas iniciales, recuperación del proceso vivido, reflexión de antecedentes y puntos de llegada), de un proyecto de iniciación tecnológica, con datos del período agosto 2021/junio 2022, a partir de la publicación de contenido transmedia, referente al cuidado de la infancia en tiempos de covid-19, siendo el público objetivo familiares de recién nacidos y niños. Resultados: se crearon y publicaron contenidos en diversas redes sociales (Instagram, Facebook, Spotify, Youtube y WhatsApp), que permitieron, durante la pandemia, compartir, de forma convergente, orientaciones científicas fidedignas y confiables. Conclusión: el transmedia en enfermería pediátrica demostró ser innovador, dinámico y fructífero, además de ser de bajo costo y con gran potencial de cobertura.

"Why would I go if the infant was healthy?": Factors Influencing Postnatal Care Utilization in Chiapas, Mexico.

Despite global efforts, postnatal care utilization remains low. There is almost no research on factors influencing postnatal care utilization in Latin America. Chiapas has one of the highest rates of maternal and neonatal mortality in Mexico. In 2014, we conducted 101 interviews with recently delivered women, male partners, traditional birth attendants (TBAs), and health staff, to assess factors influencing postnatal care utilization. Data underwent content analysis and thematic coding. Travel costs, postnatal seclusion practices, and a low perceived need for postnatal care were found to be disincentives to seek care. Providers ascribed low care adherence to cultural beliefs and low health literacy, while families indicated that their decision to seek facility care was mediated by the TBA's recognition of danger signs and perceived ability to manage complications. TBAs should be leveraged as gatekeepers, health literacy programs should emphasize the importance of primary care, and structural barriers to care should be reduced.

Mortalidad neonatal y las infecciones asociadas a la atención sanitaria / Neonatal mortality and healthcare-associated infections

Objetivo: Analizar la mortalidad neonatal y las infecciones asociadas a la atención sanitaria. Método: Se realizó una revisión sistemática de 15 artículos en PubMed y Scielo, los cuales se relacionan directamente con el objetivo de investigación. Conclusión: Las diferentes medidas de asepsia y antisepsia aplicados en UCIN y Neonatología, han disminuido la incidencia de IAAS, aunque, aún hay una alta tasa de mortandad por sepsis, neumonías y meningitis, las cuales provocan hasta una cuarta parte de todas las muertes de recién nacidos, siendo los más afectados los neonatos con un peso menor a 1500 gramos

Objective: To analyze neonatal mortality and healthcare-associated infections. Methods: A systematic review of 15 articles in PubMed and Scielo, which are directly related to the research objective, was carried out. Conclusion: The different asepsis and antisepsis measures applied in NICU and Neonatology have decreased the incidence of HAIs, although there is still a high mortality rate due to sepsis, pneumonia and meningitis, which cause up to a quarter of all newborn deaths, the most affected being neonates weighing less than 1500 grams.

Cardiomyopathy and cardiac function in fetuses and newborns of diabetic mothers

Abstract Objective: To evaluate cardiac function and structural changes in children of diabetic mothers in the fetal and neonatal period using Doppler-echocardiographic data. Method: A prospective, descriptive observational study conducted in a private and tertiary care service for high-risk pregnant women. It included 48 children of mothers with gestational diabetes mellitus (GDM) considered clinically compensated during pregnancy, with a single fetus and absence of malformations. Myocardial thickness, shortening fraction, left ventricular (LVMPI) and right ventricular (RVMPI) myocardial performance index, and mitral and tricuspid valve E/A ratio were evaluated in 96 echocardiographic exams with Doppler. Results: The hypertrophic cardiomyopathy was 29% vs 6% p = 0.006 in the prenatal and postnatal periods respectively. The shortening fraction was 0% vs 6% p = 0.242 in the fetuses and newborns respectively. The myocardial performance index of the right ventricle was 12% vs 54% p ≤ 0.001, and on the left ventricle 27% vs 60% p = 0.001 in the prenatal and postnatal periods respectively. The ratio of mitral valve E/A waves was 6% vs 50% p ≤ 0.001 and the ratio of tricuspid valve E/A waves was 0% vs 27% p 0.001 in the fetuses and newborns respectively. Conclusion: A decrease in the rate of myocardial hypertrophy and changes in cardiac function parameters were observed in the fetal and neonatal periods.

Association between prenatal care adequacy indexes and low birth weight outcome / Associação entre índices de adequação de cuidado prénatal e desfecho de baixo peso ao nascer

Abstract Objective To investigate the association between prenatal care (PNC) adequacy indexes and the low birth weigth (LBW) outcome. Methods A total of 368,093 live term singleton births in the state of Rio de Janeiro (Brazil) from 2015 to 2016 were investigated using data from the Brazilian Live Birth Information System (Sistema de Informações sobre Nascidos Vivos, SINASC, in Portuguese). Seven PNC adequacy indexes were evaluated: four developed by Brazilian authors (Ciari Jr. et al., Coutinho et al., Takeda, and an index developed and used by the Brazilian Ministry of Health - MS) and three by authors from other countries (Kessner et al., the Adequacy of Prenatal Care Utilization index - APNCU, and the Graduated Prenatal Care Utilization Index - GINDEX). Adjusted odds ratios were estimated for the PNC adequacy indexes by means of multivariate logistic regression models using maternal, gestational and newborn characteristics as covariates. Results When the PNC is classified as "inadequate", the adjusted odds ratios to the LBWoutcome increase between 42% and 132%, depending on which adequacy index is evaluated. Younger (15 to 17 years old) and older (35 to 45 years old) mothers, those not married, of black or brown ethnicity, with low schooling (who did not finish Elementary School), primiparous, with preterm births, as well as female newborns had increasing odds for LBW. The models presented areas under the receiver operating characteristic (ROC) curve between 80.4% and 81.0%, and sensitivity and specificity that varied, respectively, between 57.7% and 58.6% and 94.3% and 94.5%. Conclusion Considering all PNC adequacy indexes evaluated, the APNCU had the best discriminatory power and the best ability to predict the LBW outcome.

Resumo Objetivo Investigar a associação entre diferentes índices de adequação do cuidado pré-natal (PN) e o desfecho de nascimentos com baixo peso (BP). Métodos Foram investigados 368.093 nascimentos ocorridos no estado do Rio de Janeiro entre 2015 e 2016, utilizando-se as informações do Sistema de Informações sobre Nascidos Vivos (Sinasc). Sete índices de adequação do cuidado PN foram avaliados: quatro propostos por autores nacionais (Ciari Jr et al., Coutinho et al., Takeda, e um índice atualmente em uso pelo Ministério da Saúde - MS), e três, por autores internacionais (Kessner et al., Adequacy of Prenatal Care Utilization index - APNCU, e Graduated Prenatal Care Utilization Index - GINDEX). As razões de chance ajustadas para BP foram estimadas considerando os índices de adequação do cuidado PN por meio de modelos de regressão logística, utilizando características maternas, da gravidez e do recém-nascido como variáveis de controle. Resultados As chances ajustadas para ocorrência de BP ao nascer aumentam de 42% a 132%, a depender do índice empregado, quando o cuidado PN é considerado inadequado. Mães entre 15 e 17 anos e entre 35 e 45 anos, sem companheiro, de cor parda ou preta, com ensino fundamental incompleto, e primíparas, com gestações pré-termo, além de bebês do sexo feminino são fatores de risco para os nascimentos com BP. Conclusão Entre os índices avaliados, o APNCU foi o que apresentou melhor poder discriminatório e capacidade de prever o desfecho de BP ao nascer.

Cardiomyopathy and cardiac function in fetuses and newborns of diabetic mothers.

OBJECTIVE: To evaluate cardiac function and structural changes in children of diabetic mothers in the fetal and neonatal period using Doppler-echocardiographic data. METHOD: A prospective, descriptive observational study conducted in a private and tertiary care service for high-risk pregnant women. It included 48 children of mothers with gestational diabetes mellitus (GDM) considered clinically compensated during pregnancy, with a single fetus and absence of malformations. Myocardial thickness, shortening fraction, left ventricular (LVMPI) and right ventricular (RVMPI) myocardial performance index, and mitral and tricuspid valve E/A ratio were evaluated in 96 echocardiographic exams with Doppler. RESULTS: The hypertrophic cardiomyopathy was 29% vs 6% p = 0.006 in the prenatal and postnatal periods respectively. The shortening fraction was 0% vs 6% p = 0.242 in the fetuses and newborns respectively. The myocardial performance index of the right ventricle was 12% vs 54% p ≤ 0.001, and on the left ventricle 27% vs 60% p = 0.001 in the prenatal and postnatal periods respectively. The ratio of mitral valve E/A waves was 6% vs 50% p ≤ 0.001 and the ratio of tricuspid valve E/A waves was 0% vs 27% p ≤ 0.001 in the fetuses and newborns respectively. CONCLUSION: A decrease in the rate of myocardial hypertrophy and changes in cardiac function parameters were observed in the fetal and neonatal periods.

Geospatial estimation of reproductive, maternal, newborn and child health indicators: a systematic review of methodological aspects of studies based on household surveys.

BACKGROUND: Geospatial approaches are increasingly used to produce fine spatial scale estimates of reproductive, maternal, newborn and child health (RMNCH) indicators in low- and middle-income countries (LMICs). This study aims to describe important methodological aspects and specificities of geospatial approaches applied to RMNCH coverage and impact outcomes and enable non-specialist readers to critically evaluate and interpret these studies. METHODS: Two independent searches were carried out using Medline, Web of Science, Scopus, SCIELO and LILACS electronic databases. Studies based on survey data using geospatial approaches on RMNCH in LMICs were considered eligible. Studies whose outcomes were not measures of occurrence were excluded. RESULTS: We identified 82 studies focused on over 30 different RMNCH outcomes. Bayesian hierarchical models were the predominant modeling approach found in 62 studies. 5 × 5 km estimates were the most common resolution and the main source of information was Demographic and Health Surveys. Model validation was under reported, with the out-of-sample method being reported in only 56% of the studies and 13% of the studies did not present a single validation metric. Uncertainty assessment and reporting lacked standardization, and more than a quarter of the studies failed to report any uncertainty measure. CONCLUSIONS: The field of geospatial estimation focused on RMNCH outcomes is clearly expanding. However, despite the adoption of a standardized conceptual modeling framework for generating finer spatial scale estimates, methodological aspects such as model validation and uncertainty demand further attention as they are both essential in assisting the reader to evaluate the estimates that are being presented.

Developing evidence briefs for policy: a qualitative case study comparing the process of using a guidance-contextualization workbook in Peru and Uganda.

BACKGROUND: Translating research evidence from global guidance into policy can help strengthen health systems. A workbook was developed to support the contextualization of the WHO's 'Optimizing health worker roles to improve maternal and newborn health' (OptimizeMNH) guidance. This study evaluated the use of the workbook for the development of evidence briefs in two countries - Peru and Uganda. Findings surrounding contextual factors, steps in the process and evaluation of the workbook are presented. METHODS: A qualitative embedded case study was used. The case was the process of using the workbook to support the contextualization of global health systems guidance, with local evidence, to develop evidence briefs. Criterion sampling was used to select the countries, participants for interviews and documents included in the study. A template-organizing style and constant comparison were used for data analysis. RESULTS: A total of 19 participant-observation sessions and 8 interviews were conducted, and 50 documents were reviewed. Contextual factors, including the cadres, or groups, of health workers available in each country, the way the problem and its causes were framed, potential policy options to address the problem, and implementation considerations for these policy options, varied substantially between Peru and Uganda. However, many similarities were found in the process of using the workbook. Overall, the workbook was viewed positively and participants in both countries would use it again for other topics. CONCLUSIONS: Organizations that produce global guidance, such as WHO, need to consider institutionalizing the application of the workbook into their guidance development processes to help users at the national/subnational level create actionable and context-relevant policies. Feedback mechanisms also need to be established so that the evidence briefs and health policies arising from global guidance are tracked and the findings coming out of such guideline contextualization processes can be taken into consideration during future guidance development and research priority-setting.

In Low- And Middle-Income Countries, Is Delivery In High-Quality Obstetric Facilities Geographically Feasible?

Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83-100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths.

Countdown to 2015 country case studies: systematic tools to address the "black box" of health systems and policy assessment.

BACKGROUND: Evaluating health systems and policy (HSP) change and implementation is critical in understanding reproductive, maternal, newborn and child health (RMNCH) progress within and across countries. Whilst data for health outcomes, coverage and equity have advanced in the last decade, comparable analyses of HSP changes are lacking. We present a set of novel tools developed by Countdown to 2015 (Countdown) to systematically analyse and describe HSP change for RMNCH indicators, enabling multi-country comparisons. METHODS: International experts worked with eight country teams to develop HSP tools via mixed methods. These tools assess RMNCH change over time (e.g. 1990-2015) and include: (i) Policy and Programme Timeline Tool (depicting change according to level of policy); (ii) Health Policy Tracer Indicators Dashboard (showing 11 selected RMNCH policies over time); (iii) Health Systems Tracer Indicators Dashboard (showing four selected systems indicators over time); and (iv) Programme implementation assessment. To illustrate these tools, we present results from Tanzania and Peru, two of eight Countdown case studies. RESULTS: The Policy and Programme Timeline tool shows that Tanzania's RMNCH environment is complex, with increased funding and programmes for child survival, particularly primary-care implementation. Maternal health was prioritised since mid-1990s, yet with variable programme implementation, mainly targeting facilities. Newborn health only received attention since 2005, yet is rapidly scaling-up interventions at facility- and community-levels. Reproductive health lost momentum, with re-investment since 2010. Contrastingly, Peru moved from standalone to integrated RMNCH programme implementation, combined with multi-sectoral, anti-poverty strategies. The HSP Tracer Indicators Dashboards show that Peru has adopted nine of 11 policy tracer indicators and Tanzania has adopted seven. Peru costed national RMNCH plans pre-2000, whereas Tanzania developed a national RMNCH plan in 2006 but only costed the reproductive health component. Both countries included all lifesaving RMNCH commodities on their essential medicines lists. Peru has twice the health worker density of Tanzania (15.4 vs. 7.1/10,000 population, respectively), although both are below the 22.8 WHO minimum threshold. CONCLUSIONS: These are the first HSP tools using mixed methods to systematically analyse and describe RMNCH changes within and across countries, important in informing accelerated progress for ending preventable maternal, newborn and child mortality in the post-2015 era.

Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care.

BACKGROUND: The majority of births in Mexico take place in a health facility and are attended by a skilled birth attendant, yet maternal mortality has not declined to anticipated levels. Coverage estimates of skilled attendance and other maternal and newborn interventions often rely on women's self-report through a population-based survey, the accuracy of which is not well established. METHODS: We used a facility-based design to validate women's report of skilled birth attendance, as well as other key elements of maternal, newborn intrapartum, and immediate postnatal care. Women's reports of labor and delivery care were collected by exit interview prior to hospital discharge and were compared against direct observation by a trained third party in a Mexican public hospital (n = 597). For each indicator, validity was assessed at the individual level using the area under the receiver operating curve (AUC) and at the population level using the inflation factor (IF). RESULTS: Five of 47 indicators met both validation criteria (AUC > 0.60 and 0.75 < IF < 1.25): urine sample screen, injection or IV medication received during labor, before the birth of the baby (i.e., uterotonic for either induction or augmentation of labor), episiotomy, excessive bleeding, and receipt of blood products. An additional 9 indicators met criteria for the AUC and 18 met criteria for the IF. A skilled attendant indicator had high sensitivity (90.1 %: 95 % CI: 87.1-92.5 %), low specificity (14.0 %: 95 % CI: 5.8-26.7 %) and was suitable for population-level estimation only. CONCLUSION: Women are able to give valid reports on some aspects of the content of care, although questions regarding the indication for interventions are less likely to be known. Questions that include technical terms or refer to specific time periods tended to have lower response levels. A key aspect of efforts to improve maternal and newborn health requires valid measurement of women's access to maternal and newborn health interventions and the quality of such services. Additional work on improving measurement of population coverage indicators is warranted.

Effects of postpartum mobile phone-based education on maternal and infant health in Ecuador.

OBJECTIVE: To evaluate the effects of a mobile phone-based intervention on postnatal maternal health behavior and maternal and infant health in a middle-income country. METHODS: A prospective evaluation enrolled consecutive postpartum women at two public hospitals in Quito, Ecuador, between June and August 2012. Inclusion criteria were live birth, no neonatal intensive care admission, and Spanish speaking. Intervention and control groups were assigned via random number generation. The intervention included a telephone-delivered educational session and phone/text access to a nurse for 30days after delivery. Maternal and infant health indicators were recorded at delivery and 3months after delivery via chart review and written/telephone-administered survey. RESULTS: Overall, 102 women were assigned to the intervention group and 76 to the control group. At 3months, intervention participants were more likely to attend the infant's postnatal check-up (P=0.022) and to breastfeed exclusively (P=0.005), and less likely to feed formula (P=0.016). They used more effective forms of contraception (more implants P=0.023; fewer condoms P=0.036) and reported fewer infant illnesses (P=0.010). There were no differences in maternal acute illness or check-up attendance. CONCLUSION: Mobile phone-based postnatal patient education is a promising strategy for improving breastfeeding, contraceptive use, and infant health in low-resource settings; different strategies are needed to influence postpartum maternal health behavior.

Management of Continuous Positive Airway Pressure in the Newborn: Impact of Lecture-based Interactive Workshops on Training for Neonatal Intensive Care Nurses / Manejo de la presión positiva continua en las vías respiratorias en el recién nacido: el impacto de talleres interactivos basados en conferencias sobre la formación de las enfermeras de cuidados intensivos neonatales / Manejo da pressão positiva contínua nas vias respiratórias no recém-nacido: o impacto de oficinas interativas baseadas em conferências sobre a formação das enfermeiras de cuidados intensivos neonatais

Objectives: The aim of this study was to determine how training imparted via structured workshops related to management of continuous positive airway pressure in the newborn affects the knowledge of neonatal intensive care nurses. Methods: A group of nurses attended an interactive lecture-based workshop on management of continuous positive airway pressure in the newborn. The nurses in question had accepted an invitation to the presentation prior to the training event. Information on the participants' differentiating features was collected via a questionnaire prepared by the researchers themselves. An evaluation of the nurses' knowledge on the subject was performed through a multiple choice questionnaire (MCQ) prepared by the researchers in relation to the literature. After the MCQ was prepared, it was mailed to experts in Turkey (7 people) and experts from abroad (5 people), and their opinions were considered. In light of their suggestions, the MCQ was given its final form and the number of questions was set at 20. The MCQ consisting of 20 questions was answered by the participants before and after the interactive workshop. The participants were not informed as to whether or not the test would be repeated after the training. Results: Thirty-six nurses from the neonatal unit took part in the study. Each question in the MCQ was considered as one (1) point. The maximum possible score on the test was 20. There was a significant improvement in the mean test score after the lecture, when compared to the pre-lecture score (Mean = 19.6, SD=0.8 vs. Mean =13.1, SD=3.0, P<0.001). Conclusions: A lecture-based inter active workshop on management of continuous positive airway pressure in newborns helps to improve nurses' knowledge. It also helps to overcome deficiencies in nurse training.

Objetivos: el objetivo de este estudio fue determinar cómo la formación impartida a través de talleres estructurados relacionados con el manejo de la presión positiva continua en las vías respiratorias en el recién nacido afecta el conocimiento de las enfermeras que trabajan en cuidados intensivos neonatales. Métodos: un grupo de enfermeras asistieron a un taller interactivo basado en una conferencia sobre el manejo de la presión positiva continua en las vías respiratorias en el recién nacido. Las enfermeras en cuestión habían aceptado una invitación para asistir a la presentación antes del evento de capacitación. La información sobre las características diferenciadoras de los participantes se recogió a través de un cuestionario elaborado por los propios investigadores. Una evaluación de los conocimientos de las enfermeras sobre el tema se llevó a cabo a través de un cuestionario de selección múltiple (CSM), el cual fue elaborado por los investigadores en relación con la literatura. El CSM fue enviado por correo a unos expertos en Turquía (siete personas) y unos expertos en el exterior (cinco personas), y sus opiniones fueron tomadas en cuenta. A la luz de sus sugerencias, al CSM se le dio su forma final y el número de preguntas se fijó en 20. El CSM, que consta de 20 preguntas, fue respondido por los participantes antes y después del taller interactivo. A los participantes no se les dijo si la prueba se repitió después del taller de formación. Resultados: treinta y seis enfermeras de la unidad neonatal participaron en el estudio. Cada pregunta en el CSM se consideró como un (1) punto. La puntuación máxima posible en la prueba fue 20. Hubo una mejora significativa en la puntuación de la prueba media después de la conferencia, si se compara con la puntuación preconferencia (media = 19,6, SD = 0,8 vs. media = 13,1, SD = 3.0, P <0,001). Conclusiones: un taller interactivo basado en una conferencia sobre el manejo de la presión positiva continua en las vías respiratorias en el recién nacido ayuda a mejorar el conocimiento de las enfermeras. También ayuda a superar las deficiencias en la formación de enfermeras.

Objetivos: o objetivo deste estudo é determinar como a formação ministrada nas oficinas estrturadas relacionadas com o manejo da pressão positiva contínua nas vias respiratórias no recém-nascido afeta o conhecimento das enfermeiras que trabalham em cuidados intesivos neonatais. Métodos: um grupo de enfermeiras participaram de uma oficina interativa baseada numa conferência sobre o manejo da pressão contínua nas vias respiratórias no recém-nascido. as enferemeiras em questão tinham aceitado um convite para comparecer à apresentação antes do evento de aperfeiçoamento. a informação sobre as características diferenciadoras dos participantes foi coletada por meio de um questionário elaborado pelos próprios pesquisadores. Uma avaliação dos conhecimentos das enfermeiras sobre o tema foi realizado mediante questionário de múltipla escolha (QME), o qual foi elaborado pelos pesquisadores de acordo com a literatura. o QME foi enviado por e-mail a sete especialistas na Turquia e a outros cinco no exterior, e suas opiniões foram consideradas. À luz das sugestões, o QME, que consta de 20 perguntas, foi respondido pelos participantes antes e depois da oficina interativa. Resultados: 36 enfermeiras da unidade neonatal participaram do estudo. Cada pergunta do QME foi considerada como (1) ponto. A pontuação máxima possível na prova foi 20. Houve uma melhora significativa na pontuação da prova média depois da conferência, se comparada com a pontuação pré-conferência (media = 19,6, SD = 0,8 vs. media = 13,1, SD = 3.0, P < 0,001). Conclusões: uma oficina interativa baseada numa conferência sobre o manejo da pressão positiva contínua nas vias respiratórias no recém-nascido ajuda a melhorar o conhecimento das enfermeiras e a superar as deficiências na sua formação.

Improving maternity care in the Dominican Republic: a pilot study of a community-based participatory research action plan by an international healthcare team.

This article is a report of the process and results of a feasibility pilot study to improve the quality of maternity care in a sample of 31 women and their newborns delivering in a public, tertiary hospital in the Dominican Republic. The pilot study was the first "action step" taken as a result of a formative, community-based participatory research (CBPR) study conducted between 2008 and 2010 by an interdisciplinary, international partnership of U.S. academic researchers, Dominican medical/nursing personnel, and Dominican community health workers. Health personnel and community health workers separately identified indicators most important to measure quality of antepartum maternity care: laboratory and diagnostic studies and respectful, interpersonal communication. At the midpoint and the completion of data collection, the CBPR team evaluated the change in quality indicators to assess improvement in care. The pilot study supports the idea that joint engagement of community health workers, health personnel, and academic researchers with data creation and patient monitoring is motivating for all to continue to improve services in the cultural context of the Dominican Republic.