Promover a parentalidade : recomendações perante as birras e momentos de alimentação da criança

Enquadramento: A parentalidade é um tema de saúde com muita relevância na sociedade atual, intervindo o seu exercício na promoção da saúde e bem-estar da criança. A parentalidade envolve acontecimentos stressantes, nomeadamente em situações de problemas de saúde e necessidades básicas e de resposta ao comportamento da criança, como é o caso do choro/birra e no momento de alimentação, procurando a maioria dos cuidadores responder ao problema de forma independente enquanto outros solicitam apoio dos profissionais de saúde. Objetivo: Identificar recomendações concretas, baseadas na evidência científica, de boas práticas e recomendações a transmitir aos pais para lidarem com o choro /birras e no momento da alimentação da criança. Métodos: Realizou-se uma revisão sistemática da literatura de estudos realizados nos idiomas português, inglês e espanhol, publicados entre 2009 e 2014, em bases de dados internacionais CINAHL® Plus with Full-Text, Nursing & Allied Health Collection, Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews (CDSR) e Database of Abstracts of Reviews of Effects (DARE), MedicLatina , MEDLINE, com recurso a diversos descritores e operadores booleanos e recorrendo a dois revisores que avaliaram a qualidade dos estudos metodológicos. Resultados: Após avaliação crítica, foram excluídos 50 estudos e incluídos 7, sendo um de grau de evidência A, dois de evidência B e 4 de evidência D. Os outcomes evidenciaram que para gestão da parentalidade o aconselhamento deve feito pelo profissional de referência, que se necessário deverá acompanhar os pais através de contacto telefónico e visita domiciliária sobretudo se mães inexperientes. Os profissionais devem ampliar os seus conhecimentos sobre as dúvidas e preocupações que os pais têm sobre a educação dos seus filhos consultando os espaços de discussão online. A etnia e nacionalidade das mães tem forte impacto sobre os métodos usados para acalmar o bebé, pelo que os cuidados devem ser culturalmente congruentes. Na abordagem do choro/ birras torna-se necessário conhecer o normal desenvolvimento da criança e em que contextos surgem para minimizá-las, sendo importante que os pais dêem à criança atenção positiva, instituindo rotinas. Para melhorar o momento da alimentação os pais devem reconhecer que até aos dois anos decorre a janela de oportunidade de aprendizagem de rotinas e de novos sabores, salientando-se a importância do ambiente de atenção e reciprocidade durante as refeições. Conclusão: Os enfermeiros devem procurar orientar a sua prática com base nas evidências científicas e tendo como base o estudo efectuado, salienta-se a promoção da parentalidade positiva como central para a abordagem dos comportamentos de choro/birra e no momento da alimentação da criança. Palavras – chaves: educação parental, enfermeiro, aleitamento materno, alimentação, birra, choro, relação pais-filhos.ABSTRACT Background: Parenting is a health issue with much relevance in today’s society, intervening its exercise in promoting the child’s health and welfare. Parenting involves stressful events, namely in health problems and basic needs situations and answer to the child’s behaviour, as is cry/tantrum and in the moment of feeding, searching most of the carers to respond to the problem independently while others look for the health professionals’ support.. AIM: Identifying the right recommendations, based on scientific evidence, good practices and recommendations to transmit to the parents in order to handle the cries/tantrums and in the moment of feeding the child. Methods: It was carried out a systematic revision to the literature of studies performed in Portuguese, English and Spanish language, published between 2009 and 2014, in international data bases CINAHL® Plus with Full-Text, Nursing & Allied Health Collection, Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE), MedicLatina, MEDLINE, with resource to several descriptors and boolean operators and turning to two reviewers that evaluate the quality of methodologic studies Results: After critical evaluation, there were excluded 50 studies and included 7, being one of a level of evidence A, two of evidence B and 4 of evidence D. The outcomes show that for parenting management the advisement should be done by the professional of reference, that if necessary will follow up the parents by phone and home visit especially if inexperienced mothers. The professionals must amplify their knowledge on the doubts and worries that parents have on their children’s education browsing the online discussion forums. The mothers’ ethnic group and nationality have strong impact over the methods used to calm the baby, so care must be culturally congruent. In the approach of cry/tantrums it becomes necessary to know the normal development of the child and in what contexts they arise to minimize them, being important that the parents give the child positive attention, establishing routines. To improve the moment of feeding parents should acknowledge that until two years old elapses the window of opportunity to learn routines and new flavours, pointing out the importance of an attention environment and mutuality during the meals. Conclusion: Nurses should orient their practice based on scientific evidence and taking support on the study carried out, it becomes conspicuous the promotion of positive parenting as nucleus to the approach of cry/tantrum behaviour and in the moment of feeding the child Key – words: parenting education, nurses, breastfeeding, feeding, tantrum, crying, child/parents bonding

Pain assessment in surgical patients with impaired cognition

Pain is considered the 5th vital sign and its measurement/assessment and records are required and must be systematic. Ineffective pain management involves complications in clinical status of patients, longer hospitalization times and higher costs with health. In the surgical patient with impaired cognition, hetero measurements should be made, based on behavioural and physiological indicators. We used to determine the efficacy and efficiency of the Observer Scale, the Abbey Pain Scale and Pain Assessment in Advanced Dementia (PAINAD). Our study is an applied, non-experimental, quantitative, descriptive and analytical research. The data collection instrument consisted of patients’ sociodemographic and clinical data, the Observer Scale, the Abbey Pain Scale (Rodrigues, 2013) and PAINAD (Batalha et al., 2012). We assessed pain at an early phase and 45 minutes after an intervention for its relief. The sample is non-probabilistic for convenience, consisting of 76 surgical patients with impaired cognition, admitted to the surgery services of a central hospital, aged between 38 and 96 years. There was a positive correlation between the results of the three scales, most evident in the initial evaluation. Pain intensity in the same patient is higher when assessed with PAINAD (OM = 2.16) and lower when assessed with the Observer Scale (OM = 1.78). The most effective and efficient scale is PAINAD. Due to the small sample size, we suggest confirmatory studies so that the results can be generalized

Das CPCJ aos tribunais da relação : caracterização dos processos de promoção e proteção

O progressivo reconhecimento do lugar que as crianças e jovens ocupam na sociedade enquanto sujeitos de direitos e a importância de incentivar, desenvolver e assegurar o exercício efetivo dos mesmos, tem convocado os interventores políticos e sociais para a observância de boas práticas em matéria de infância e juventude. Mas nem sempre foi desta forma, e existirá ainda um longo caminho a percorrer no que respeita a esta temática. Neste trabalho foi feito o enquadramento da evolução dos direitos da criança até se chegar à intervenção no âmbito da Lei 147/99. Esta intervenção foi depois seguida, desde o seu início até à chegada a sede judicial, através da análise de 92 acórdãos que implicam a matéria de facto. Obtiveram-se resultados que apontam para a maior frequência da aplicabilidade das medidas de “confiança a instituição com vista a futura adoção” e “acolhimento residencial” pelos Tribunais de Família e Menores e da Relação. Também foi possível apurar que a maioria dos recursos são indeferidos pelos Tribunais de Relação. Este estudo aponta para a necessidade de intervenção precoce em matéria de promoção e protecção, para que se possam evitar muitas vezes situações remediativas que acontecem, assim como para a importância do trabalho de acompanhamento das famíliasThe progressive recognition of the place that children and young people have in society as subjects of rights and the importance of encourage, develop and secure its effective exercise, has summoned the political and social intervenors to observe good practices within childhood and youth. It hasn’t always been like this and there’s still a long way to run regarding this issue. In this report we’ve approached the children’s rights evolution until reaching the intervention under the law 147/99. This intervention has been followed since its beginning until reaching the judicial seat, through the analysis of judgements which imply this matter.Results were obtained which aim to a greater frequency of the applicability of measures related with “the trust on an institution regarding a future adoption” and “child residential reception”. Among other results, it was also possible to gather that most of the appeals are denied by Supreme Court. This study aims to the need of early intervention, which can avoid many of the fixing situations happening, as well as the importance of working with the families and families monitoring

In vivo antithrombotic effects of a nitric oxide-releasing aspirin derivative, NCX-4016.

In summary, these results demonstrate that NCX-4016 can inhibit thrombus formation in an in vivo model. This effect is most likely due to nitric oxide release from the compound, but may also be dependent, to some extent, on suppression of thromboxane synthesis. It is possible that in certain circumstances, a dual mechanism of action in inhibiting platelet aggregation, together with the documented ability of NCX-4016 to inhibit neutrophil adherence, could offer distinct advantages over agents that only inhibit platelet aggregation through a single mechanism. The marked increase in gastric tolerability of NCX-4016 over that of aspirin also represents an attractive feature of this compound as a prophylactic therapy for thrombotic disorders

A controlled study of transitional day care for non-chronically-ill patients.

The authors randomly assigned 79 inpatients with nonchronic schizophrenia or affective disorder to either an intensive experimental day program called transitional treatment or a control treatment--weekly clinically believed to require intensive posthospital treatment to make the transition to the community. Although initially there was a significantly higher dropout rate from the control condition, at the point of discharge from the two programs as well as at 6- and 12-month follow-up there was no difference in outcome. Direct costs for the transitional treatment, however, were much higher

Antiplatelet drugs reduce the immunoinflammatory response in a rat model of periodontal disease

Background and ObjectiveAfter activation, platelets express mediators that modulate inflammation. We hypothesized that drug-induced platelet inactivation may interfere in the inflammatory process in experimental periodontal disease by suppressing the release of biological mediators to the injury site.Material and MethodsTo evaluate the effects of antiplatelet drugs on experimental periodontal disease, 60 rats were randomly assigned to six groups (n=10) and ligatures were placed around lower first molars in three groups. The other three groups were not subjected to the induction of periodontal disease and were used as negative controls. During the experimental period, animals were given aspirin (30mg/kg) or clopidogrel (75mg/kg) intragastrically once daily for 3d. On day 3, they were killed and gingival tissue were used to evaluate myeloperoxidase activity and the expression of the chemokine CXCL4. Hemi-mandibles were used for microscopic evaluation.ResultsClopidogrel significantly reduced the inflammatory infiltrate and increased the amount of collagen fibers. Histometric analysis showed that clopidogrel impaired alveolar bone loss. Expression of CXCL4 was significantly increased (p<0.001) in rats subjected to periodontal disease. Systemic administration of aspirin and clopidogrel induced a significant decrease ( p<0.05) in the expression of CXCL4. Treatment with antiplatelet drugs resulted in a significant reduction of myeloperoxidase activity when compared to saline-treated animals with periodontal disease.ConclusionClopidogrel but not aspirin showed the ability of preventing bone loss in experimental periodontitis.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Comparative Bioavailability Of Two Suspension Formulations Of Potassium Diclofenac In Healthy Male Volunteers.

The bioavailability of two suspension formulations of potassium diclofenac (Flogan, Merck and Cataflam, Ciba-Geigy) were compared in eighteen healthy male volunteers who received a single dose of 7 ml of each suspension (equivalent to 105 mg of potassium diclofenac) in an open randomized two period crossover design, with a fourteen-day washout period between doses. Serum samples were obtained over a 24 hour interval and diclofenac concentrations were determined by HPLC with ultraviolet detection. From the serum diclofenac concentration vs time curves, AUC[0-24] (area under the concentration vs time curves from 0-24 h), Cmax (maximum achieved concentration), Tmax (time to achieve Cmax) and Ke (terminal first order elimination constant) were obtained. Overlapping of Tmax intervals for both formulations was observed, but the important inter-subject variation observed in Cmax ratios did not allow equivalence conclusion for the rate of absorption. Equivalence in the extent of bioavailability between both potassium diclofenac suspension brands was concluded from the analysis of AUC[0-24] ratios.32131-

Cognitive impairment in obstructive sleep apnea syndrome: a descriptive review

Purpose: Obstructive sleep apnea syndrome is a clinical sleep disorder defined by total or partial airflow restraint during sleep that results in fragmented sleep and hypoxemia, impacting negatively with cognitive functioning. This review was conducted on studies investigating structural brain alteration and cognitive impairment in obstructive sleep apnea syndrome. Method: We searched on PubMed databases and screening references of included studies and review articles for additional citations. From initial 190 publications, only 17 met search criteria and described the cognitive impairment in obstructive sleep apnea syndrome. Results: Findings showed that patients with this syndrome had worse performance than healthy controls in attention, memory, and executive functions, showing specific neuroanathomical features. Cognitive impairment is also related to the severity of pathology. Treatment could improve certain cognitive aspects. Conclusions: Cognitive deficits seem to be mainly attributable to decreased daytime vigilance and nocturnal hypoxemia

Conversion of immunosuppressive monotherapy from cyclosporin A to tacrolimus reverses bone loss in rats

Tacrolimus is used for transplant patients with refractory graft rejection and those with intolerance to cyclosporin (CsA), without the disfiguring adverse effects frequently attributed to CsA therapy. Since we have shown that CsA-associated bone loss can also affect alveolar bone, the purpose of this study was to evaluate the effects of conversion of monotherapy from CsA to tacrolimus on alveolar bone loss in rats. Groups of rats were treated with either CsA (10 mg/kg/day, s.c.), tacrolimus (I mg/kg/day, s.c.), or drug vehicle for 60 and 120 days, and an additional group received CsA for 60 days followed by conversion to tacrolimus for a further 60-day period. Bone-specific alkaline phosphatase (BALP), tartrate-resistent acid phosphatase (TRAP-5b), calcium (Ca2+), interleukin (IL)-1 beta, IL-6, and tumor necrosis factor alpha (TNF-alpha) concentrations were evaluated in the serum. Analyses of bone volume, bone surface, number of osteblasts, and osteoclasts were performed. Treatment with CsA for either 60 or 120 days was associated with bone resorption, represented by lower bone volume and increased number of osteoclasts; serum BALP, TRAP-5b, IL-1 beta, IL-6, and TNF-alpha were also higher in these animals. After conversion from CsA to tacrolimus, all the altered serum markers returned to control values in addition to a significant increase of bone volume and a lower number of osteoclasts. This study shows that conversion from CsA to tacrolimus therapy leads to a reversal of the CsA-induced bone loss, which can probably be mediated by downregulation of IL-1 beta, IL-6, and TNF-alpha production