Nurses' perception and practice towards the humanization of antenatal care and delivery in high-risk maternity hospitals

Orientador: Maria Yolanda MakuchTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivo: Estudar a percepção e prática dos profissionais de enfermagem em relação à incorporação de ações de humanização na assistência a gestação e parto. Método: Foi realizado um estudo qualitativo e uma revisão integrativa da literatura. A seleção dos participantes foi por amostragem proposital, e o número de participantes foi determinado pelo critério de saturação teórica dos dados. A coleta de dados ocorreu no ano de 2015, no ambulatório do pré-natal de alto risco e no centro obstétrico de duas maternidades públicas de atenção terciária localizadas nas regiões Sudeste (maternidade A) e Nordeste (maternidade B) do Brasil. A amostra foi composta por dois grupos de participantes. Um grupo foi formado por enfermeiros que realizavam assistência ao pré-natal e o outro por enfermeiros do centro obstétrico das duas maternidades. Foram realizadas entrevistas semiestruturadas utilizando um roteiro temático. Todas as entrevistas foram gravadas e transcritas na íntegra. Os dados foram analisados por meio da técnica de análise de conteúdo na modalidade temática. As categorias de análise foram organizadas de acordo com as recomendações propostas pelas políticas públicas de humanização da assistência e dos temas emergentes. Resultados: Para a revisão integrativa da literatura foram selecionados 28 artigos. Evidenciaram-se a necessidade de valorização da formação do enfermeiro para a humanização do parto e a limitação da atuação do enfermeiro decorrente das precárias condições de trabalho, do modelo biomédico presente nas instituições e dos fatores socioculturais. Participaram do estudo de campo 21 enfermeiros, destes seis trabalhavam no ambulatório de pré-natal de alto risco (três da maternidade A e três da maternidade B) e 15 atuavam no centro obstétrico (seis da maternidade A e nove da maternidade B). As enfermeiras que trabalhavam no pré-natal consideraram que a humanização consiste no acolhimento da gestante, assistência individualizada e formação do vínculo. Nas duas maternidades referiram às visitas nas maternidades, grupos de gestantes, orientações sobre os métodos não farmacológicos para o alívio da dor durante o trabalho de parto e incentivo à presença do acompanhante. Relataram a necessidade de aperfeiçoar o conhecimento dos profissionais sobre as politicas de humanização, melhorar a comunicação da equipe, a captação precoce da gestante, aprimorar os materiais educativos e garantir as gestantes o local do parto. Os participantes do centro obstétrico consideraram que a humanização da assistência à parturiente consiste no atendimento holístico, escuta qualificada e nas orientações sobre a evolução do trabalho de parto. A prática do enfermeiro no parto foi distinta nas duas maternidades e no puerpério imediato favoreceram o contato pele-a-pele e o incentivo ao aleitamento materno. Relataram que a estrutura física das duas instituições contribuiu para as práticas de humanização. Conclusão: Os enfermeiros compreendem o conceito de humanização do pré-natal e do parto. No pré-natal as práticas de humanização em comum nas duas maternidades foram o acolhimento, a assistência individualizada e o vínculo com a gestante; e às práticas de assistência ao parto foram distintas nas duas maternidades. Os enfermeiros do pré-natal sugeriram a melhoria da comunicação da equipe, dos materiais educativos e da implantação de uma política interna das instituições para direcionar as ações de humanização; e do centro obstétrico relataram a necessidade de capacitação contínua e valorização do enfermeiro. As facilidades para as práticas de humanização do pré-natal e parto nas duas maternidades foram à estrutura física adequada, as visitas guiadas no centro obstétrico, o trabalho multidisciplinar e o acesso a informações. No centro obstétrico as dificuldades para a prática de humanização foram à insuficiência de enfermeiros, a pouca articulação das ações multidisciplinares e o uso inadequado das salas PPPAbstract: Objective: To study the perspective and practice of nursing professionals towards the development of actions to humanize pregnancy and delivery. Method: A qualitative study and an integrative literature review were conducted. Participants were selected using purposive sampling and the number of participants was determined according to the theoretical saturation of the data. Data collection took place in the year 2015 at the high risk antenatal outpatient clinic and the obstetric center of two public tertiary-level maternity hospitals located in Southern (Hospital A) and Northeastern (Hospital B) Brazil. The sample consisted of two groups of participants. One group was composed of nurses who provided antenatal care and the other included nurses from the obstetric centers of both hospitals. Semi-structured interviews were carried out using a thematic guide. All interviews were recorded and transcribed verbatim. The data were submitted to content analysis. The analytical categories were organized according to the recommendations of the public policies for the humanization of care and the emerging themes. Results: The integrative review included 28 articles. The need to valorize nurses¿ training for the humanization of delivery and the limitation of nurses¿ performance due to precarious working conditions, the biomedical model present in the institutions and sociocultural factors were evident. The field study included 21 nurses. Of these, six worked at the high risk antenatal outpatient clinic (three from Hospital A and three from Hospital B) and 15 worked at the obstetric center (six from Hospital A and nine from Hospital B). The nurses who provided antenatal care reported that humanization consisted of: actions related to pregnant women¿s embracement, individualized care, and bonding between pregnant women and professionals. Professionals from both hospitals reported conducting guided visits to the maternity ward and orientation groups of pregnant women, provided guidelines on nonpharmacological methods for pain relief during labor and encouraged the presence of the companion. They reported the need to enhance professionals¿ knowledge about humanization policies, improve team communication, perform early registration of pregnant women, improve educational materials, and ensure pregnant women¿s access to a birthing room. Participants working at the obstetric center considered that the humanization of the care provided to parturient women consists of holistic care, qualified listening and guidance on the evolution of labor. Nurses¿ practices during delivery were different in both hospitals and they favored skin-to-skin contact and encouraged breastfeeding in the immediate puerperium. They reported that the physical structure of the two institutions contributed to the development of humanization practices. Conclusion: The nurses understand the concept of humanized antenatal care and delivery. The practices for humanizing antenatal care in both hospitals included user¿s embracement, individualized care, and bonding between pregnant women and professionals. The practices for humanizing delivery care were different in both hospitals. The nurses providing antenatal care suggested the improvement of team communication and educational materials, and the implementation of an internal policy to guide humanization actions. The nurses working at the obstetric center reported the need for continued tracing of pregnant women and valorization of nurses. Factors facilitating practices for the humanization of antenatal care and delivery in both hospitals were the adequate physical structure, the guided visits to the obstetric center, the multidisciplinary work, and the access to information. Difficulties for developing humanization practices at the obstetric center were related to the shortage of nurses, the little articulated multidisciplinary work, and the inadequate use of birthing roomsDoutoradoSaúde Materna e PerinatalDoutora em Ciências da Saúd

Which NoSQL Database? A Performance Overview

NoSQL data stores are widely used to store and retrieve possibly large amounts of data, typically in a key-value format. There are many NoSQL types with different performances, and thus it is important to compare them in terms of performance and verify how the performance is related to the database type. In this paper, we evaluate five most popular NoSQL databases: Cassandra, HBase, MongoDB, OrientDB and Redis. We compare those databases in terms of query performance, based on reads and updates, taking into consideration the typical workloads, as represented by the Yahoo! Cloud Serving Benchmark. This comparison allows users to choose the most appropriate database according to the specific mechanisms and application needs

Municipal revenue over-budgeting: a dynamic analysis of its determinants

Published online: 17 Jan 2022This paper investigates which factors affect revenue over-budgeting in the local government, considering budgetary, political, and institutional determinants. It applies dynamic panels analysis to data from Portuguese municipalities between 2005 and 2017. Regarding budgetary arrangements, over-budgeting has implications for several years, taking up to three years to dissipate. The difference between budgeted revenues and the ones collected in the previous year is a good predictor that revenue is overestimated. The ratio of own-source over total revenue is directly related with over-budgeting; however, this effect comes from the municipality’s wealth. About political factors, municipal Executives with political majorities and in electoral years are more prone to over-budget; however, ideology does not seem to be important. As for institutional arrangements, participation in any debt restructuring program is inversely related to over-budgeting, while excessive debt does not seem to play any role. Overall, the only mechanism which reduces over-budgeting misbehavior is external control.This research was funded by the Foundation for Science and Technology of the Portuguese Ministry for Education and Science, Refs UIDB/05037/2020 and UIDB/ CPO/00758/2020

Concurrent and construct validation of a new scale for rating perceived exertion during elastic resistance training in the elderly

Purpose: To examine the concurrent and construct validity of a new perceptual scale to control the exercise intensity using elastic bands (Resistance Intensity Scale for Exercise; RISE) in the elderly. Methods: Twenty-six participants underwent two sessions consisting of 4 exercises. The participants performed three sets of 15 repetitions per exercise of either low, medium, or high intensity. The criterion variables were heart rate and applied force (mean and peak). Following the final repetition of each set, active muscle (AM) and overall body (OB) ratings of perceived exertion (RPE) were collected from RISE and the OMNI-Resistance Exercise Scale of perceived exertion with elastic bands (OMNI-RES EB). Construct validity was established by correlating the perceptual score obtained from both scales, RISE and OMNI-RES EB. Results: Significant (p ≤ 0.05) and positive linear relationships between both scales were found (RPE-AM R2 = 0.90; RPE-OB R2 = 0.77). Significant differences in heart rate applied force, and RISE scores were observed between the sets of the three intensities. For all 4 analyzed exercises, high-intensity sets elicited higher heart rate, applied force, and perceptual scores compared with the medium- and low-intensity sets. Furthermore, the medium-intensity sets produced higher perceptual, physiologic, and performance responses than the low-intensity sets. Intersession reliability was 0.88 for heart rate, 0.94 and 0.95 for applied force, 0.88 for the RPE-AM, and 0.80 for the RPEOB. Conclusion: The RISE scale can be considered a valid method for assessing the perceived exertion during resistance exercises performed with bands in the elderly

ESTADO DA ARTE: APRENDIZAGEM BASEADA EM PROJETOS E O ENSINO DA FÍSICA

This article aims to analyze what has been worked on in the active methodology “Project Based Learning” (ABP), in Physics teaching contexts, contributing to the elaboration of new research and school practices. There is a special interest in verifying whether the teaching of Physics can promote meaningful learning, using methodologies, which place the student at the center of the learning process. The results indicated a variety of theoretical and methodological assumptions related to the PBL methodology, as well as the concern of the authors to provide students with more engaged learning which relates to real-world situations present in the students’lives, seeking more meaningful learning. Factors that may hinder the implementation of PBL proposals are also identified if they are not taken into account.Este artículo tiene como objetivo analizar el trabajo realizado con la metodología activa “Aprendizaje Basado en Proyectos” (ABP), en el contexto de enseñanza de la Física, contribuyendo a la elaboración de nuevas investigaciones y prácticas escolares. Es de interés especial verificar si la enseñanza de la Física puede promover aprendizajes significativos, utilizando metodologías que coloquen al alumno en el centro del proceso de aprendizaje. Los resultados indicaron una variedad de supuestos teóricos y metodológicos con respecto a la metodología ABP, así como la contribución de los autores por brindar a los estudiantes un aprendizaje más atractivo, que se relacione con situaciones reales presentes en la vida cotidiana, buscando un aprendizaje más significativo. El estudio también consideró si se toman en cuenta los factores que pueden obstaculizar la implementación de las propuestas de PBL.O presente artigo tem como objetivo analisar o que vem sendo trabalhado na metodologia ativa “Aprendizagem Baseada em Projetos” (ABP), em contextos de ensino de Física, contribuindo para a elaboração de novas pesquisas e práticas escolares. Há especial interesse em verificar se o ensino de Física pode promover aprendizagem significativa, a partir de metodologias, que posicionem o estudante no centro do processo de aprendizagem. Os resultados indicaram uma variedade de pressupostos teóricos e metodológicos relativos à metodologia ABP, bem como a preocupação dos autores em proporcionar aos estudantes uma aprendizagem mais envolvente, que tenha relação com situações reais presentes na vida cotidiana, buscando uma aprendizagem mais significativa. Também são identificados fatores que podem atrapalhar a implantação de propostas ABP se não forem levados em consideração

A Multi-Start Algorithm for Solving the Capacitated Vehicle Routing Problem with Two-Dimensional Loading Constraints

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Hepatitis C antibody prevalence and behavioral correlates in people who inject drugs attending harm reduction services in Lisbon, Portugal

Copyright © 2022 Curado, Nogueira, Virgolino, Santa Maria, Mendão, Furtado and Antunes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.The hepatitis C virus (HCV) infection is an important public health problem, affecting millions of people worldwide. People who inject drugs (PWID) are at increased risk of HCV infection due to, among other factors, widespread unsafe injecting practices, such as sharing of infected equipment or unprotected sexual practices. In Portugal, there is a lack of data regarding the proportion of infected persons through injecting drug use. This study aimed to evaluate the anti-HCV prevalence and behavioral correlates of infection in PWID attending harm reduction services in the Metropolitan Area of Lisbon, Portugal. A cross-sectional study with a purposive sample of PWID was undertaken between March 2018 and March 2020. Participants were recruited through the harm-reduction services of a nongovernmental organization. A rapid diagnostic test for anti-HCV screening was performed. Data on drug consumption history and current practices, past HCV testing, care and treatment history, and knowledge regarding hepatitis C were also collected through a questionnaire applied by trained inquirers. A total of 176 PWID participated in this study. An overall prevalence of 70.5% of anti-HCV positive in this population was found. Those with an anti-HCV positive testing result tended to start consuming at a younger age and have a higher consumption of benzodiazepines in the last 30 days. Sharing needles and other injecting material is a frequent risk behavior among this group. Also, they are more likely to have attended an opioid agonist treatment and to have undertaken previous hepatitis C and HIV tests in the past. This study represents an important effort to better understand the HCV prevalence and behavioral correlates of infection among PWID in Portugal, as well as to better estimate those in need of HCV treatment.This study was funded by Gillead Sciences Portugal (https://www.gilead.com/utility/global-operations/europe/portugal/portugal-translation) and Fundação para a Ciência e a Tecnologia (https://www.fct.pt/), grant numbers UIDB/04295/2020 and UIDP/04295/2020.info:eu-repo/semantics/publishedVersio

High -and moderate-intensity resistance training provokes different effects on body composition, functionality, and well-being in elderly

Purpose: To compare the short-term effects of a resistance training program with elastic bands at moderate and high intensity on the body composition, functional capacity, and well-being of overweight and obese older women. Method: 75 women (68.7 ± 4.7 years) were assigned to a control group (n = 25) or to one of two treatment groups: (i) high intensity (G6 = 6 repetitions, n = 25) and (ii) moderate intensity (G15 = 15 repetitions, n = 25). Body composition (fat and fat-free mass), functional capacity (isometric strength; 30-s-arm-curl, 30-s-chair-stand, timed up & go test, and 6-min-walk-test [6MWT]), and well-being were evaluated before and after 8 weeks of intervention by using the 36-Item-Short-Form-Survey (SF-36). Results: 61 participants completed the study. The G15 group generated greater positive changes in the percentages of total and segmental fat mass (≃2.8%, p ≤ .05) and better performance in the 6MWT than the other groups. The G6 group showed greater improvements in the timed up & go and muscle strength tests than the G15 group. The G6 and G15 groups showed significant improvements in the following sections of SF-36: general health perceptions, physical functioning, mental health, and vitality. The performance of all variables worsened in the control group. Conclusions: The 8 weeks of intervention caused positive and significant changes in all study variables, although the results confirmed that this duration is insufficient to generate clear differences according to the level of exercise intensity. Nevertheless, G15 caused greater improvements in the percentage of fat mass and in aerobic resistance, whereas G6 improved the lower-limb muscle strength.This work was supported by the grant Ignacio Larramendi 2014 from the Mapfre Foundation (Code: OTR2015-140931NVES). Pedro Gargallo was supported by a predoctoral scholarship (FPU15/05634) awarded by the Spanish Ministry of Education, Culture, and Sport