Statistical validation for the portuguese population

Objective: To translate the Neonatal Unit Parental Stress scale into Portuguese and culturally and linguistically adapt it for Portugal, and to evaluate the psychometric qualities of the Neonatal Unit Parental Stress Assessment Scale - Modified Version (EASPUN-MV). Method: This was a quantitative methodological study to validate the Neonatal Unit Parental Stress Assessment Scale. Parents were selected by non-probabilistic sampling (n = 406 parents). Descriptive statistics, standardized Cronbach's alpha, and confirmatory factor analysis were used to calculate the sensitivity, validity, and reliability of the Neonatology Unit Parental Stress Assessment Scale (indexes of the model's goodness of fit χ2/df, CFI, TLI, RMSEA, P(RMSEA). Results: The empirical indexes of the EASPUN-MV’s factorial model showed acceptable goodness of fit (χ2/df=3.3; CFI=0.8; GFI=0.8; TLI=0.8 and P(RMSEA)=0.07). Conclusion: The Neonatology Unit Parental Stress Assessment Scale - Modified Version is a psychometrically sensitive, valid and reliable instrument that can systematically assess parental stress and facilitate the decision-making of nurses, the follow-up care of parents, and their referral to other healthcare professionals.info:eu-repo/semantics/publishedVersio

as respostas dos pais ao stress na unidade de cuidados neonatais

O internamento do recém-nascido na Unidade de Cuidados Neonatais é uma fonte de stress para os pais devido ao ambiente agressivo e à fragilidade do seu filho, mas também devido à dificuldade em estabelecer e desenvolver processos de vinculação. Sabendo que os pais desempenham um papel decisivo no desenvolvimento do seu filho e que necessitam de apoio para compreender este papel, é importante que os profissionais de saúde, nomeadamente os enfermeiros, reconheçam os fatores protetores e stressors associados às experiências vividas pelos pais, de modo a prestar cuidados holísticos, não-traumáticos, promotores do desenvolvimento e centrados na família. Este Relatório é o produto da aprendizagem experiencial e formação reflexiva obtida com as experiências nos diversos contextos de estágio, onde, através das atividades desenvolvidas e da concretização dos objetivos delineados, se adquiriram contributos para o desenvolvimento das competências que compõem o perfil do Enfermeiro Especialista, do Enfermeiro Especialista em Enfermagem de Saúde Infantil e Pediátrica e de Mestre em Enfermagem. Sustenta-se na filosofia dos Cuidados Centrados na Família e, na perspetiva de compreender como os stressors influenciam o equilíbrio do Sistema-Família, apoia-se no Modelo dos Sistemas de Neuman. A realização do estudo de investigação denominado Experiências de Parentalidade. As respostas dos pais ao stress na Unidade de Cuidados Neonatais, começou com a tradução, validação e adaptação da escala Neonatal Parental Stress (NUPS) para a população portuguesa, no sentido de uniformizar a avaliação do stress parental, as intervenções promotoras da parentalidade e, assim, dar uma maior consistência aos cuidados de enfermagem e uma maior visibilidade dos mesmos. Estas atividades contribuíram para a disseminação do conhecimento e a sua translação para a prática, promovendo o desenvolvimento de competências e a mobilização de recursos para resolver novas situações no contexto de trabalho através da capacidade para analisar, tomar decisões e agir

influência do tempo de internamento e diferenciação da unidade de neonatologia

info:eu-repo/semantics/publishedVersio

revisão scoping

Enquadramento: A utilização de instrumentos de avaliação do stress parental na Unidade de Neonatologia, permite que o enfermeiro conheça as fontes promotoras de stress que influenciam as respostas dos pais e implementar práticas de cuidados consistentes, adequadas e centradas na família. Objetivo: o objetivo desta revisão scoping é identificar e mapear na literatura científica os instrumentos de avaliação do stress parental na Unidade de Neonatologia e as fontes promotoras de stress aí existentes. Método: O protocolo da revisão scoping seguiu o modelo da JBI e a pesquisa foi realizada com recurso a 11 bases de dados. Consideraram-se estudos primários, secundários e literatura cinzenta. Após análise integral do texto dos artigos subsistiram 39 que foram incluídos na revisão. Resultados: Existem dois instrumentos de avaliação do stress parental desenvolvidos especificamente para utilizar na Unidade de Neonatologia: Parental Stressor Scale: Neonatal Intensive Care Unit – PSS: NICU e Neonatal Unit Parental Stress-NUPS. As fontes de stress existentes na Unidade de Neonatologia que mais concorrem para o stress parental são o relacionamento dos pais com o recém-nascido e a alteração do papel parental. Conclusão: esta revisão indiciou o estado da evidência científica sobre os instrumentos de avaliação de stress parental na Unidade de Neonatologia e as principais fontes promotoras de stress. A utilização de instrumentos de avaliação do stress parental permite identificar os stressores que influenciam as respostas dos pais enquanto cuidam do recém-nascido na Unidade de Neonatologia. Os resultados que emergem da aplicação destes instrumentos facilitam o conhecimento das necessidades parentais e consequentemente o desenvolvimento de intervenções promotoras do papel parental e a parentalidade.Introduction:The use of parental stress assessment instruments in the Neonatology Unit, allows nurses to know the stress-promoting sources that influence the parents' responses and to implement consistent, adequate, and family-centered care practices. Objective: the objective of this scoping review is to identify and map in the scientific literature the instruments for assessing parental stress in the Neonatology Unit and the sources that promote stress there. Method: the scoping review protocol followed the JBI model and the research was carried out using 11 databases. Primary and secondary studies and gray literature were considered. After a full analysis of the text of the articles, 39 remained and were included in the review. Results: there are two Palavras-chave:Escalas;Stress Psicológico; Pais; Recém-Nascido; Neonatologia. 66Pensar Enfermagem | Vol. 24 | N.º 2 | 2º Semestre de 2020 Keywords: Scale; Psychological stress; Parents; Newborn; Neonatology instruments for assessing parental stress, developed specifically for use in the Neonatology Unit: Parental Stressor Scale: Neonatal Intensive Care Unit -PSS: NICU and Neonatal Unit Parental Stress-NUPS. The sources of stress in the Neonatology Unit that contribute most to parental stress are the relationship of the parents with the newborn and the change in the parental role. Conclusion: this review indicated the state of scientific evidence on the instruments for assessing parental stress in the Neonatology Unit and the main sources of stress. The use of parental stress assessment instruments allows the identification of stressors that influence parents' responses while caring for the newborn in the Neonatology Unit. The results that emerge from the application of these instruments facilitate the knowledge of parental needs and, consequently, the development of interventions that promote parental role and parenting.info:eu-repo/semantics/publishedVersio

Increase in the number of nutritionists in the primary health care in Brazil : Contributions of the Support Centers for Family Health and Family Health Strategy from 2007 to 2013

Objetivo: identificar a evolução do quantitativo de nutricionistas atuantes na Atenção Básica nos municípios brasileiros, com ênfase nas Equipes de Saúde da Família e nos Núcleos de Apoio à Saúde da Família. Métodos: estudo descritivo utilizando dados secundários do número de nutricionistas, tempo no serviço, tipo de equipe, estabelecimentos onde são cadastrados e perfil dos municípios brasileiros, solicitados pela equipe da pesquisa e fornecidos pelo Ministério da Saúde, com base no Cadastro Nacional de Estabelecimentos de Saúde no período de 2007 a 2013. Foi utilizada a estatística descritiva. Resultados: o número de nutricionistas aumentou ao longo dos anos porque mais municípios brasileiros contrataram estes profissionais. O incremento foi mais acentuado (cerca de 700% entre 2008 e 2013) para os Núcleos de Apoio à Saúde da Família, nos quais o profissional é o terceiro mais presente, após psicólogos e fisioterapeutas. Pequena parcela dos nutricionistas (6-15%) permaneceu no cargo por mais de cinco anos; o percentual variou de acordo com o ano e com o tipo de equipe. Os municípios de pequeno porte, pertencentes à região Nordeste e com Índice de Desenvolvimento Humano Municipal médio, foram os que mais contrataram profissionais nutricionistas. Por outro lado, houve um menor aumento, de 75%, no número de nutricionistas contratados para as Unidades Básicas/Centros de Saúde (excluindo os profissionais dos Núcleos e da Estratégia Saúde da Família). Conclusão: foi constatado o aumento do número de nutricionistas na Atenção Básica, bem como o aumento no número de municípios que contrataram este profissional, principalmente para os Núcleos de Apoio à Saúde da Família. A manutenção dessa taxa de aumento poderá influenciar na inversão da proporção de nutricionistas da Atenção Básica, em relação aos outros níveis de atenção à saúde, como a média e alta complexidade.Objective: identify the increase in the number of nutritionists in the Primary Health Care in Brazilian municipalities focusing on Family Health Teams and Support Centers for Family Health. Methods: a cross-sectional descriptive study was conducted using secondary data for the number of nutritionists, their length of employment, type of teams established, their workplace, and the profile of Brazilian municipalities. The data were provided upon request by the Ministry of Health, based on the National Cadastre of Health Establishments in the period of 2007-2013. Descriptive statistics was used. Results: the number of nutritionists increased over the years since more Brazilian municipalities hired these professionals. This increase was greater (around 700% between 2008 and 2013) in the Support Centers for Family Health, in which nutritionists are the third most common professionals, after psychologists and physiotherapists. A small proportion of nutritionists (6-15%) remained on their job for more than five years; this number varied according to the year and the type of team. The small-sized cities, located in the Northeastern region, with intermediate levels of Municipal Human Development Index, were the ones that hired more nutritionists. On the other hand, there was a smaller rate increase (75%) in the number of nutritionists hired to work in Basic Health Care Units/Health Centers (excluding those professionals for Family Health Strategy and Centers). Conclusion: it was observed an increase in the number of nutritionists in the Primary Health Care and in the number of municipalities that hired these professionals, especially in the case of the Support Centers for Family Health. Maintaining this growth rate may change the proportion of nutritionists in Primary Health Care in relation to those working in other health care levels, such as secondary and tertiary health care

The neonatal palliative care attitude scale: psychometric properties for portuguese neonatal nurses

Background. This study is aimed to perform the translation and cultural adaptation of the Neonatal Palliative Care Attitude Scale (NiPCAS) and evaluation of its psychometric properties with Portuguese neonatal nurses. Methods. The research started with a scoping review that allowed the identification of the NiPCAS. It was a methodological study with a quantitative approach. The semantic equivalence of the items was adjusted with the participation of 20 neonatal nurse experts. They performed facial and quantitative content validation. Psychometric validation of the NiPCAS was performed on a nonprobability nurses sample (n = 283) in 13 level 3 neonatal units between July 2021 and February 2022. Confirmatory factor analysis using the polychoric correlation matrix was performed to estimate factor validity using the “lavaan” package for R statistical software. Internal consistency was estimated using Cronbach’s alpha coefficient, and item sensitivity was assessed using the asymmetry and kurtosis coefficients. Empirical indices were considered: chi-square over degrees of freedom; comparative fit index; normed fit index; Tucker–Lewis index, and root mean square error of approximation; average extracted variance and composite reliability were used to assess convergent validity. Results. Asymmetry and kurtosis were <|3| and <|7|, respectively, suggesting psychometric sensitivity. The convergent validity of the factors was: F1, FCF1 = 0.90 and for F2, FCF2 = 0.80, and a lower value for F3, FCF3 = 0.40. According to the squared correlation criterion average variance extracted (AVE) between the factors, there was no discriminant validity for F1 and F2, but there was discriminant validity for F1, F3, F2, and F3. Significance of results. This instrument has implications for providing end-of-life care to newborns and their families. The use of this instrument reveals several barriers and facilitating elements inherent in the organization and culture of the facility and nursing education.info:eu-repo/semantics/publishedVersio

Impact of a dietary supplement on the nutritional status of preschool children enrolled in day care centers

Objetivo: Avaliar o impacto da suplementação da dieta com multimistura sobre o estado nutricional de crianças em fase pré-escolar em risco nutricional. Métodos: Trata-se de estudo tipo duplo cego com duração de dois meses e acompanhamento longitudinal de 135 crianças na faixa etária de um a seis anos. As crianças foram divididas em três grupos: intervenção 1 (GI1 n=48), intervenção 2 (GI2 n=45) e controle (GC n=42), recebendo 5g e 10g de multimistura e placebo, respectivamente. O estado nutricional das crianças em estudo foi avaliado antes e após a suplementação. Resultados: Não houve diferença significativa nos indicadores peso/idade, altura/idade e peso/altura entre os grupos estudados na linha base (p=0,251 p=0,248 e p=0,399, respectivamente). Após a intervenção a diferença na prevalência de déficit antropométrico entre os grupos também não foi significante (p=0,100 p=0,435 ep=0,210, respectivamente). A comparação das médias antes e depois da intervenção, igualmente, não demonstrou diferenças (p>0,05 utilizando os métodos estatísticos de Kruskall - Wallis e Análise de Variância). Conclusão: Frente ao impacto das pequenas quantidades consumidas de suplemento, no caso a mistura de farelo de cereais, não se justifica esperar alterações significativas sobre a recuperação de crianças em risco nutricional, já que esses suplementos contêm somente pequenas quantidades de calorias e de macromicronutrientes.Objective: The objective of this study was to evaluate the impact of a diet supplemented with a bran-based cereal mixture on the nutritional status of preschool children presenting nutritional risk. Methods: This was a two-month double-blinded study with a longitudinal follow up using 135 children with ages ranging from one to six years old and divided into three groups: intervention 1 (GI1=48), intervention 2 (GI2 n=45) and control (CG n=42), receiving 5g and 10g of the multi-mixture and placebo, respectively. The nutritional situation of the children in the study was evaluated before and after supplementation. Results: No significant differences were observed in the weight/age, height/age and weight/height indicators at the base line (p=0.251 p=0.248 and p=0.399 respectively) between the groups studied. After intervention, the difference between the groups in the prevalence of anthropometrical deficit was also not significant (p=0.100 p=0.435 and p=0.210 respectively) and a comparison of the averages before and after intervention revealed no differences (p>0.05 using the Kruskall - Wallis and Analysis of Variance statistical methods). Conclusion: In the specific case of the bran-based mixture, the impact of the small amounts of supplement ingested did not warrant expecting alterations in the recovery of children presenting nutritional risk, since these supplements contain only small amounts of calories and macro and micronutrients

Prevalence of thyroid dysfunction in patients with diabetes mellitus

BACKGROUND: Diabetes mellitus (DM) and thyroid dysfunction (TD) are the two most common endocrine disorders in clinical practice. The unrecognized TD may adversely affect the metabolic control and add more risk to an already predisposing scenario for cardiovascular diseases. The objective of this study was to investigate the prevalence of TD in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM). METHODS: This is an observational cross-sectional study. Three hundred eighty-six (386) patients with T1DM or T2DM that regularly attended the outpatient clinic of the Diabetes unit, Hospital Universitário Pedro Ernesto, participated in the study. All patients underwent a clinical and laboratory evaluation. Thyroid dysfunction was classified as clinical hypothyroidism (C-Hypo) if TSH > 4.20 μUI/mL and FT4 < 0.93 ng/dL; Subclinical hypothyroidism (SC-Hypo) if TSH > 4.20 μUI/ml and FT4 ranged from 0.93 to 1.7 ng/dL; Subclinical hyperthyroidism (SC-Hyper) if TSH < 0.27 μUI/ml and FT4 in the normal range (0.93 and 1.7 ng/dL) and Clinical hyperthyroidism (C-Hyper) if TSH < 0.27 μUI/ml and FT4 > 1.7 μUI/mL. Autoimmunity were diagnosed when anti-TPO levels were greater than 34 IU/mL. The positive autoimmunity was not considered as a criterion of thyroid dysfunction. RESULTS: The prevalence of TD in all diabetic patients was 14,7%. In patients who had not or denied prior TD the frequency of TD was 13%. The most frequently TD was subclinical hypothyroidism, in 13% of patients with T1DM and in 12% of patients with T2DM. The prevalence of anti-TPO antibodies was 10.8%. Forty-four (11.2%) new cases of TD were diagnosed during the clinical evaluation. The forty-nine patients with prior TD, 50% with T1DM and 76% with T2DM were with normal TSH levels. CONCLUSIONS: We conclude that screening for thyroid disease among patients with diabetes mellitus should be routinely performed considering the prevalence of new cases diagnosed and the possible aggravation the classical risk factors such as hypertension and dyslipidemia, arising from an undiagnosed thyroid dysfunction

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.info:eu-repo/semantics/publishedVersio