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

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

Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports

<p>Abstract</p> <p>Background</p> <p>Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied.</p> <p>Methods</p> <p>Two case reports of BRONJ involving RA patients were discussed</p> <p>Results</p> <p>Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved.</p> <p>Conclusions</p> <p>This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.</p

Eco-epidemiological analysis of rickettsial seropositivity in rural areas of Colombia: A multilevel approach

ABSTARCT: Rickettsiosis is a re-emergent infectious disease without epidemiological surveillance in Colombia. This disease is generally undiagnosed and several deadly outbreaks have been reported in the country in the last decade. The aim of this study is to analyze the eco-epidemiological aspects of rickettsial seropositivity in rural areas of Colombia where outbreaks of the disease were previously reported. A cross-sectional study, which included 597 people living in 246 households from nine hamlets in two municipalities of Colombia, was conducted from November 2015 to January 2016. The survey was conducted to collect sociodemographic and household characteristics (exposure) data. Blood samples were collected to determine the rickettsial seropositivity in humans, horses and dogs (IFA, cut-off = 1/128). In addition, infections by rickettsiae were detected in ticks from humans and animals by real-time PCR targeting gltA and ompA genes. Data was analyzed by weighted multilevel clog-log regression model using three levels (person, household and hamlets) and rickettsial seropositivity in humans was the main outcome. Overall prevalence of rickettsial seropositivity in humans was 25.62% (95%CI 22.11-29.12). Age in years (PR = 1.01 95%CI 1.01-1.02) and male sex (PR = 1.65 95%CI 1.43-1.90) were risk markers for rickettsial seropositivity. Working outdoors (PR = 1.20 95%CI 1.02-1.41), deforestation and forest fragmentation for agriculture use (PR = 1.75 95%CI 1.51-2.02), opossum in peridomiciliary area (PR = 1.56 95%CI 1.37-1.79) and a high proportion of seropositive domestic animals in the home (PR20-40% vs 40% vs <20% = 3.14 95%CI 2.43-4.04) were associated with rickettsial seropositivity in humans. This study showed the presence of Rickettsia antibodies in human populations and domestic animals. In addition, different species of rickettsiae were detected in ticks collected from humans and animals. Our results highlighted the role of domestic animals as sentinels of rickettsial infection to identify areas at risk of transmission, and the importance of preventive measures aimed at curtailing deforestation and the fragmentation of forests as a way of reducing the risk of transmission of emergent and re-emergent pathogens

Evaluation of argyrophilic nucleolar organizer regions in oral tumor progression

The aim of this study was to compare the presence of nucleolar organizer regions (NORs) in normal oral mucosa, dysplasia and microinvasive carcinoma. All histological specimens were reviewed according to the modified classification and staging system for oral leukoplakia described by van-der-Waal et al. [Oral Oncol. 36 (2000) 264]. NOR quantification was performed with an image analyzer after staining by the argyrophilic nucleolar region technique. The morphometric results were statistically different for normal mucosa, dysplasia and microinvasive carcinoma. It was concluded that an increase of NOR activity follows the disease progression and may reflect the degree of cellular proliferation and malignancy.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Combined effects of cyclosporin and nifedipine on gingival overgrowth in rats is not age dependent

Background: Cyclosporin A and nifedipine cause gingival overgrowth in rat, and the combined use of these drugs increases the overgrowth severity. Objective: The purpose of this study was to compare gingival overgrowth of rats of differents ages treated with cyclosporin A and nifedipine alone or given concurrently. Materials and methods: Rats 15, 30, 60 and 90 d old were treated with 10 mg/kg body weight of cyclosporin A and/or 50 mg/kg body weight of nifedipine in the chow. Results: Young rats showed evident gingival overgrowth with nifedipine, cyclosporin A, and cyclosporin A and nifedipine given concurrently. Adult rats did not show significant gingival alterations when treated with cyclosporin A and nifedipine alone. Nevertheless evident gingival overgrowth with alterations of the epithelium and connective tissue were observed when treated simultaneously with cyclosporin A and nifedipine. Conclusion: These results suggest that the combined effects of cyclosporin A and nifedipine on gingival overgrowth in rat is not age dependent

Influence of age on combined effects of cyclosporin and nifedipine on rat alveolar bone

Background: There is some evidence showing that cyclosporin A (CsA) and nifedipine (NIF) affect bone metabolism. The purpose of this work was to study the effects of CsA and NIF, given alone or concurrently, on alveolar bone of rats of different ages. Methods: Rats 15, 30, 60, and 90 days old were treated daily with 10 mg/kg body weight of CsA subcutaneously injected and/or 50 mg/kg body weight of NIF/day given orally for 60 days. Alveolar bone of the first lower molars was morphologically and stereologically evaluated in serial 5 μm bucco-lingual paraffin sections, stained with hematoxylin and eosin. Serum calcium and alkaline phosphatase levels were measured in all animals at the end of the experimental period. Results: Rats treated with CsA or NIF alone or CsA and NIF concurrently showed decreased alveolar bone density. CsA was more effective than NIF. A significant decrease in serum calcium was found only in animals treated with CsA or CsA/NIF. The results were similar regardless of age. Conclusions: These results indicate that the decrease in the alveolar bone volume in rats caused by CsA and NIF alone or concurrently is not age dependent. Furthermore, NIF (50 mg/kg) did not further increase the loss of alveolar bone volume induced by CsA (10 mg/kg)

Morphological evaluation of combined effects of cyclosporin and nifedipine on gingival overgrowth in rats

It has previously been shown that, while cyclosporin A (CsA) and nifedipine both cause gingival overgrowth in the rat. the combined use of these drugs increases the severity of overgrowth. The aim of this study was to describe the histometry and densities of fibroblasts, collagen fibers and vessels in the gingival tissue of rats that were treated with CsA and nifedipine, either alone or in combination. Rats were treated for 60 days with a daily subcutaneous injection of 10 mg/kg body weight of CsA and/or with 50 mg/kg body weight of nifedipine added to the chow. The results confirmed that CsA causes a more severe overgrowth than nifedipine, and that the combined use of these drugs increases the overgrowth severity. All the rat groups that were studied showed that, as the severity of overgrowth increased, there was a parallel increase in fibroblasts and collagen, and a decrease in vessel content. Therefore, independently of whether the gingival overgrowth was caused by CsA alone, nifedipine alone, or both treatments in combination, the fibroblast and collagen density increased in parallel with the severity of the overgrowth. © Blackwell Munksgaard, 2002