Práticas obstétricas segundo a OMS: expectativas, percepção e satisfação da mulher

Enquadramento: A forma como a mulher percepciona as práticas obstétricas varia em função de um amplo e diverso conjunto de factores individuais, socioculturais e situacionais. Conhecer o que a mulher considera importante dos cuidados de saúde, o que espera, o que encontra e o que sente, permite-nos adequar a assistência proporcionada às necessidades da mulher, melhorando o nível de satisfação e a qualidade dos cuidados prestados. Objectivos: Avaliar a percepção, as expectativas e satisfação da mulher relativamente às práticas obstétricas durante o Trabalho de parto (TP), parto e pós-parto (PP). Determinar a influência de factores sócio-demográficos e obstétricos nessa percepção. Analisar a relação entre a percepção e a importância dos cuidados recebidos, a nível de “cuidados prestados”, “actuação perante a dor”, “apoio sócio-familiar”, “atenção ao bem-estar” e “atenção ao PP/alta”. Determinar se as expectativas e satisfação da mulher relativamente às práticas obstétricas durante o TP, parto e PP influenciam a sua percepção. Métodos: Trata-se de estudo quantitativo, descritivo, analítico-correlacional, de corte transversal. A amostra é constituída por 405 mulheres internadas nos serviços de Obstetrícia / Puerpério de hospitais da região Centro. A colheita de dados foi realizada através de um questionário que numa primeira parte possibilitou fazer caracterização sócio-demográfica e obstétrica e incluímos a escala de Importância e Percepção das Práticas Obstétricas e o Questionário de Experiência e Satisfação com o Parto. Resultados: A importância manifestada pela mulher perante as práticas obstétricas influencia altamente o modo esta as percepciona, sendo que a importância manifestada é maior que a sua percepção. A satisfação que as mulheres apresentam durante o TP e parto é superior às suas expectativas e à medida que o internamento decorre, as expectativas e a satisfação da mulher vão melhorando. Contudo, a expectativa da mulher durante o TP, parto e PP não se mostrou preditora da percepção, ao contrário da satisfação que se revelou preditora. Também, um elevado número (58,40%) de intervenções de rotina são realizadas e apenas 66,39% das mulheres são esclarecidas sobre estas intervenções. O estado civil, a gravidez desejada, a preparação para o parto e a paridade são factores que não influenciam a percepção da mulher. Pelo contrário, a idade é preditora da percepção, sendo as mulheres mais velhas as que apresentam uma maior percepção relativamente aos cuidados prestados. Também, as mulheres com actividade laboral, com menos habilitações literárias (1º ciclo) e que vivem só com o companheiro mostram uma melhor percepção na actuação perante a dor, na atenção ao PP/alta e na atenção ao bem-estar, respectivamente. Uma vigilância adequada da gravidez (≥6 consultas) relaciona-se com uma maior percepção no apoio sócio-familiar. As mulheres com parto eutócico, as que estiveram menos de seis horas em TP e as que não induziram o parto apresentam uma melhor percepção na atenção ao bem-estar. De igual forma, as mulheres que entraram em TP espontâneo e com parto eutócico apresentam uma maior percepção no apoio sócio-familiar, sendo que o parto normal também se relacionou com uma melhor percepção na atenção ao PP/alta. No entanto, são as mulheres com parto distócico as que manifestam uma melhor percepção na actuação perante a dor. As mulheres que tiveram oportunidade de caminhar referem uma melhor percepção nos “cuidados prestados”, na “actuação perante a dor” e no “apoio sócio-familiar”. Conclusão: Conhecer as expectativas, a satisfação e a percepção da mulher perante as práticas obstétricas, entendendo os factores que se associam a esta percepção, permite aos profissionais introduzir mudanças e desenvolver estratégias em procura da excelência no cuidar. Palavras-chave: Percepção, expectativas, satisfação, práticas obstétricas.ANALYTICAL SUMMARY Background: How a woman perceives the obstetrical practices varies according to a broad and diverse set of individual factors, socio-cultural and situational. Knowing what the woman considers it important to health care, what you expect, what is and what she feels, allows us to tailor the assistance provided to women's needs, improving the level of satisfaction and quality of care. Objectives: To evaluate the perception, expectations and satisfaction in relation to women's obstetric practices during labor (TP), childbirth and postpartum (PP). To determine the influence of socio-demographic and obstetric this perception. To analyze the relationship between perception and importance of care received, the level of "care", "action before the pain," "family and social support", "attention to the welfare" and "attention to the PP / high." Determine whether the expectations and satisfaction in relation to women's obstetric practices during the TP and PP delivery influence their perception. Methods: It is quantitative, descriptive, analytical and correlational cross-sectional. The sample consisted of 405 women hospitalized in the obstetric services / Postpartum Center of hospitals in the region. Data collection was conducted through a questionnaire that allowed a first part to socio-demographic and obstetric and include the scale of importance and perception of Obstetric Practice and Experience Questionnaire and Satisfaction with childbirth. Results: The importance expressed by the woman in the face of obstetric practices strongly influence the way she perceives this, and expressed the importance is greater than its perception. The satisfaction that women have during the TP and birth beyond their expectations and as the relocation takes place, expectations and satisfaction of women is going to improve. However, the expectation of women during the TP and PP delivery was not a predictor of perception, unlike the satisfaction that proved predictive. Also, a high number (58.40%) of routine interventions are performed and only 66.39% of women are informed about these interventions. Marital status, desired pregnancy, preparation for birth and parity are factors that do not influence the perception of women. Rather, age is a predictor of perception, being the older women who have a greater awareness on the care provided. Also, women with work activity, with fewer qualifications (first degree) and who live only with fellow show a better perception on performance for the pain, attention to the PP / high care and welfare, respectively. Adequate monitoring of pregnancy (≥ 6 queries) is related to an increased awareness in family and social support. Women with normal delivery, those that were less than six hours in labor and delivery that did not induce a better insight in the present attention to the well-being. Similarly, women who went into spontaneous TP and normal delivery have an increased awareness in the family and social support, and vaginal delivery was also associated with a better understanding of attention to the PP / high. However, women with dystocia those that show a better perception on performance for the pain. Women who had the opportunity to walk in relate a better understanding "care" in the "performance for the pain" and "family and social support." Conclusion: Know the expectations, satisfaction and perception of women before the obstetrical practices, understanding the factors that are associated with this perception, allows professionals to make changes and develop strategies in pursuit of excellence in care. Keywords: Perceptions, expectations, satisfaction, obstetrical practices

Conhecimentos sobre aleitamento e a relação com a sua prevalência

Objective: Determine the level of knowledge about maternal breastfeeding and analyze to what extent this influences the intention to breastfeed after the introduction of infant feeding at the 6th and 16th weeks and at 6 months postpartum. Method: Prospective descriptive study conducted with pregnant women in Galicia (Spain). By means of a self-filling questionnaire, data were collected on the intention of the woman to feed the newborn and their knowledge about breastfeeding. Pregnant women were also contacted at the 6th and 16th weeks and at 6 months postpartum to know the type of feeding they gave their child. Results: 297 pregnant women participated in the study, of which 90.4% wanted to exclusively breastfeed their baby, however, only 28.2% continued up to 6 months. The level of knowledge about breastfeeding was regular and it was observed that it influences both the intention and the type of feeding of the newborn, thus it is an element to be considered when developing educational strategies aimed at increasing breastfeeding rates. Conclusion: The level of pregnant women’s knowledge about breastfeeding is regular and influences the choice of how to feed their babies and the duration of exclusive breastfeeding. Strategies should be implemented to increase knowledge and improve breastfeeding rates

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Cuentos de nunca acabar. Aproximaciones desde la interculturalidad

Cuentos de nunca acabar. Aproximaciones desde la interculturalidad, surge después de la pandemia y su imposibilidad de socializar “en persona” con los compañeros de eventuales encuentros, porque la Comprensión Lectora tenía que reinventarse para su nueva reflexión cognitiva, adaptación contextual y reconstrucción del conocimiento. Este renovado enfoque de la realidad postpandemia, concebido en el marco de la educación intercultural comunitaria, busca potencializar los entornos naturales, sociales y culturales como recursos de aprendizaje multidisciplinario a través del lenguaje animado de los cuentos. En este marco, había que dinamizar la asignatura de Comunicación Oral y Escrita, que se dicta en los Primeros Niveles de los Centros de Apoyo de Otavalo, Cayambe, Latacunga y Riobamba, mediante un eje transversal donde los estudiantes escriban fundamentados en valores de la cosmovisión andina, considerando que provienen de varios lugares de la sierra y amazonía ecuatoriana. Todo surgió del encuentro presencial de un sábado cualquiera donde los estudiantes realizaban ejercicios narrativos, logrando una apreciable respuesta de imaginación, más emotiva que la clásica tarea de las Unidades, tanto así que, pasados unos días, seguían llegando sus escritos a mi correo. Entonces nos pusimos manos a la obra, cada estudiante tendría dos opciones como Actividad Integradora, la primera consistía en escribir un cuento de su propia inspiración, y la segunda analizar un clásico para comentar sus valores y antivalores. La mayor parte de estudiantes decidió escribir su propio cuento, de donde se escogieron algunas participaciones que podrían considerarse originales, para una edición que, respetando la transcripción de la tradición oral que prima en los sectores comunitarios, nos concretamos en revisar la puntuación y ortografía para publicarlos. Con esto buscamos innovar la Actividad Integradora, por algo más práctico y operativo para configurar los Objetos de Aprendizaje que buscamos. Así nació, en medio del camino, este libro de Cuentos de nunca acabar. Aproximaciones desde la interculturalidad, que ponemos en sus manos. Hernán Hermosa Mantilla Quito, junio de 202

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Breastfeeding knowledge and relation to prevalence

ABSTRACT Objective: Determine the level of knowledge about maternal breastfeeding and analyze to what extent this influences the intention to breastfeed after the introduction of infant feeding at the 6th and 16th weeks and at 6 months postpartum. Method: Prospective descriptive study conducted with pregnant women in Galicia (Spain). By means of a self-filling questionnaire, data were collected on the intention of the woman to feed the newborn and their knowledge about breastfeeding. Pregnant women were also contacted at the 6th and 16th weeks and at 6 months postpartum to know the type of feeding they gave their child. Results: 297 pregnant women participated in the study, of which 90.4% wanted to exclusively breastfeed their baby, however, only 28.2% continued up to 6 months. The level of knowledge about breastfeeding was regular and it was observed that it influences both the intention and the type of feeding of the newborn, thus it is an element to be considered when developing educational strategies aimed at increasing breastfeeding rates. Conclusion: The level of pregnant women’s knowledge about breastfeeding is regular and influences the choice of how to feed their babies and the duration of exclusive breastfeeding. Strategies should be implemented to increase knowledge and improve breastfeeding rates

Revista Temas Agrarios Volumen 26; Suplemento 1 de 2021

1st International and 2nd National Symposium of Agronomic Sciences: The rebirth of the scientific discussion space for the Colombian Agro.1 Simposio Intenacional y 2 Nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano