The influence of mode of delivery on neonatal and maternal short and longterm outcomes

OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45–60 days and 6–8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1–0.31 and elective C-section: 0.36, 95%CI 0.27–0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29–0.63 and elective C-section: 0.44, 95%CI 0.33–0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2–0.88) and roomed-in less 0.85 (95%CI 0.77–0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04–1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14–2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction

Ansiedade e Depressão na Morbidade Materna Grave e Near Miss

To verify the prevalence of anxiety and depression in women with severe maternal morbidity (near miss), a cross-sectional cohort study was conducted, with 549 women. The Beck Depression Inventory (BDI) and the Anxiety Inventory (BAI) were used. For the statistical analysis, the Pearson chi-square test and the U-Mann-Whitney test besides Odds Ratio and their 95% confidence intervals. There was a higher prevalence and a greater chance of developing anxiety and depression in the SAMM/NM, as well as the positive and significant relationship between both. We consider association from the psychological point of view as a serious and shocking factor in the mental health of women.Com o objetivo de verificar a prevalência da ansiedade e depressão em mulheres com morbidade materna grave (near miss), foi realizado estudo de coorte transversal, com 549 mulheres. Para tanto, foram utilizados o Inventário de Beck de Depressão (BDI) e o Inventário de Ansiedade (BAI). Na análise estatística, aplicaram-se o teste do qui-quadrado de Pearson e o U-Mann-Whitney, além de Razões de Chances brutas e seus Intervalos com 95% de confiança. Houve maior prevalência e maior chance de desenvolver a ansiedade e depressão na MMG/NM, bem como a relação positiva e significativa entre ambos. Considera-se a associação do ponto de vista psicológico, como um fator grave e impactante na saúde mental da mulher

Construction and validation of the Self-care Assessment Instrument for patients with type 2 diabetes mellitus

Objetivo: construir e validar o conteúdo do instrumento Avaliação do Autocuidado para pacientes com diabetes mellitus tipo 2. Método: estudo metodológico, fundamentado na Teoria Geral de Enfermagem de Orem. As categorias empíricas e os itens do instrumento foram elucidados por meio de grupo focal. O processo de validação de conteúdo foi realizado por sete especialistas e a análise semântica por 14 pacientes. Foram considerados como excelente Índice de Validade de Conteúdo dos itens ≥ 0,78 e da escala ≥ 0,90. Resultados: o instrumento contém seis dimensões correspondentes aos requisitos de autocuidado para o desvio da saúde, desmembradas em 131 itens. Quanto à permanência, obteve-se para o conjunto total de itens Índice de Validade de Conteúdo de 0,98, e quanto à adequação Índice de Validade de Conteúdo ≥ 0,80 para maioria dos critérios psicométricos avaliados. Conclusão: o instrumento mostrou evidências de validade de conteúdo.Objetivo: construir y validar el contenido del instrumento Evaluación del Autocuidado para pacientes con diabetes mellitus tipo 2. Método: estudio metodológico, fundamentado en la Teoría General de Enfermería de Orem. Las categorías empíricas y los ítems del instrumento fueron elucidados por medio de grupo focal. El proceso de validación de contenido fue realizado por siete especialistas y el análisis semántico por 14 pacientes. Fueron considerados como excelente el Índice de Validez de Contenido de los ítems ≥ 0,78 y la escala ≥ 0,90. Resultados: el instrumento contiene seis dimensiones correspondientes a los requisitos de autocuidado para los agravios a la salud, desmembradas en 131 ítems. En cuanto a la permanencia, se obtuvo 0,98, para el conjunto total de ítems del Índice de Validez de Contenido y en la adecuación del Índice de Validez de Contenido ≥ 0,80, para la mayoría de los criterios psicométricos evaluados. Conclusión: el instrumento mostró evidencias de validez de contenido.Objective: to construct and validate the contents of the Self-care Assessment instrument for patients with type 2 diabetes mellitus. Method: methodological study, based on Orem's General Theory of Nursing. The empirical categories and the items of the instrument were elucidated through a focus group. The content validation process was performed by seven specialists and the semantic analysis by 14 patients. The Content Validity Indices of the items, ≥0.78, and of the scale, ≥0.90, were considered excellent. Results: the instrument contains 131 items in six dimensions corresponding to the health deviation self-care requisites. Regarding the maintenance, a Content Validity Index of 0.98 was obtained for the full set of items, and, regarding the relevance, Content Validity Indices ≥0.80 were obtained for the majority of the assessed psychometric criteria. Conclusion: the instrument showed evidence of content validity

COMPARAÇÃO DE DIMENSÕES DE PARCELAS PARA ANÁLISE DE VEGETAÇÃO EM UM FRAGMENTO DE MATA ATLÂNTICA, ARACAJU, SE

In an Atlantic Forest fragment, located at the Environmental Protection Area of "Morro do Urubu", a vegetation analysis was conducted in order to compare different plot dimensions. The area was divided into 314 plots of 20 x 100 m, and then 15 sampling points were randomly selected, 15 plots of 20 x 50 m (1000 m2) and 15 plots of 10 x 100 m (1000 m2) were installed, from each one of the sampled points. In the plots, we measured the circumference at breast height (CBH - 1.30 m height) and the total height of individuals with CBH > 31cm, using a measuring tape and a telescopic pole, respectively. In addition, we collected botanical material for scientific identification of species. The statistical test used to detect whether there was difference between independent treatments (different plot dimensions) was the Mann-Whitney test. The test showed that the following variables: height (p = 0 838), DAP (p = 0.461), basal area (p = 0.713), number of trees (p = 0.653) and number of species (p = 0.868) were not statistically meaningful among them.Em um fragmento florestal de Mata Atlântica, localizado na Área de Proteção Ambiental (APA) Morro do Urubu, foi realizado um estudo de análise de vegetação com o objetivo de comparar duas dimensões de parcelas retangulares do mesmo tamanho. Para a execução do estudo, a área foi dividida em 314 unidades amostrais de 20 m x 100 m e, posteriormente após foram sorteados aleatoriamente 15 pontos amostrais, sendo instaladas 15 parcelas de 20 m x 50 m (1000 m2) e 15 parcelas de 10 m x 100 m (1000 m2), a partir de cada um dos pontos sorteados. Nas parcelas, foram medidas a circunferência à altura do peito (CAP (cm) – 1,30 m de altura) e a altura total (m) dos indivíduos que apresentaram CAP > 31,4 cm, utilizando-se fita métrica e vara telescópica, respectivamente. Além disso, foi coletado material botânico dos indivíduos para identificação científica das espécies. O teste estatístico utilizado para detectar se ocorreu diferença entre tratamentos independentes (diferentes dimensões das parcelas) foi o teste de Mann-Whitney. O teste demonstrou que para as variáveis: altura (p = 0,838), DAP (p = 0,461), área basal (p = 0,713), número de indivíduos (p = 0,653) e número de espécies (p = 0,868) não houve diferenças estatisticamente significativas. AbstractPlot dimension comparison for vegetation analysis in an Atlantic Forest fragment, Aracaju, SE. In an Atlantic Forest fragment, located at the Environmental Protection Area of "Morro do Urubu", a vegetation analysis was conducted in order to compare different plot dimensions. The area was divided into 314 plots of 20 x 100 m, and then 15 sampling points were randomly selected, 15 plots of 20 x 50 m (1000 m2) and 15 plots of 10 x 100 m (1000 m2) were installed, from each one of the sampled points. In the plots, we measured the circumference at breast height (CBH - 1.30 m height) and the total height of individuals with CBH > 31cm, using a measuring tape and a telescopic pole, respectively. In addition, we collected botanical material for scientific identification of species. The statistical test used to detect whether there was difference between independent treatments (different plot dimensions) was the Mann-Whitney test. The test showed that the following variables: height (p = 0 838), DAP (p = 0.461), basal area (p = 0.713), number of trees (p = 0.653) and number of species (p = 0.868) were not statistically meaningful among them.Keywords: Floristic; tropical forest; conservation units

Prevalence, treatment, and control of dyslipidemia in diabetic participants of two Brazilian cohorts: a place far from heaven

Diabetes is one of the leading causes of cardiovascular mortality. Over the last years, mortality has decreased significantly, more in individuals with diabetes than in healthy ones. That is mostly due to the control of other cardiovascular risk factors. The objective of our study was to analyze the dyslipidemia control in two diabetes cohorts. Patients from two distinct cohorts were studied, 173 patients from the BHS (Brasilia Heart Study) and 222 patients from the BDS (Brazilian Diabetes Study). The data on dyslipidemia control were studied in both different populations. All patients had diabetes. There are significant differences concerning comorbidities between the LDL-C and BDS groups. The average glycated hemoglobin is of 8.2 in the LDL-C > 100 group in comparison with 7.7 and 7.5 in the 70-100 and 100 groups (54.3% and 54.9%, respectively; p = 0.005). Diastolic pressure is higher in the group with LDL > 100, with an average of 87 mmHg, in comparison with 82.6 mmHg and 81.9 mmHg in the 70-100 and 100 has the greatest percentage of smokers (8.7%) in comparison with the groups with LDL between 70-100 and 100 groups, respectively (p < 0.001). The data in our study have shown that the dyslipidemia control in diabetic patients is inadequate and there is a tendency of direct association between lack of blood glucose control and lack of dyslipidemia control, in addition to the association with other cardiovascular risk factors, such as diastolic hypertension and smoking. This worsened control might be related to the plateau in the descending curve of mortality, and investments in this regard can improve the cardiovascular health in diabetic patients.6513