Clinical and sociodemographic factors associated with the quality of life of children and adolescents with type 1 diabetes

OBJECTIVE

To analyze clinical and sociodemographic factors associated with the health-related quality of life of children and adolescents with type 1 Diabetes Mellitus.

METHOD

A quantitative, cross-sectional and analytical study, developed in a municipality in northeastern Brazil, between March and September 2021, with 81 children/adolescents with type 1 Diabetes Mellitus and their guardians/caregivers. A questionnaire containing sociodemographic and clinical variables and two quality of life instruments were used. Descriptive and inferential analysis was carried out.

RESULTS

Adolescents whose parents had a family income greater than a minimum wage had a lower prevalence of impaired quality of life when compared to those with a lower income. Adolescents with time since diagnosis of less than four years had a satisfactory quality of life, and children aged 8 to 12 years who self-administered insulin had a lower prevalence of high quality of life compared to those who did not.

CONCLUSION

Adolescents with a family income of less than a minimum wage, diagnosis time of more than four years and children aged 8-12 who self-administer insulin need greater professional support to have a better quality of life.

Educational action to monitor children's growth and development based on the theory of meaningful learning

OBJECTIVE

Evaluating the effect of an educational program on the knowledge of Primary Health Care nurses regarding the surveillance of growth and development during childcare appointments.

METHOD

A before-after intervention study with 30 nurses. The nurses' knowledge and practice assessment were done using a tool that had been developed and validated. The educational activity was carried out, linking child growth and development indicators with public policies for early childhood and nurses' practices. David Ausubel's Significant Learning Theory was used as a teaching-learning strategy. The same instrument was reapplied after one month. Descriptive statistics were used in the analysis and the proportion test, Wilcoxon test and Item Response Theory with the Rasch model were applied.

RESULTS

The nurses checked more items right in the instrument after the intervention; there was an increase in the scores of correct answers and a decrease in the item response difficulty index in the knowledge and practice section, post-intervention.

CONCLUSION

The educational activity had a positive effect, affecting changes in nurses' knowledge and practice, which enabled childcare consultations to become more qualified.

Impact of the Covid-19 pandemic on the use of screens in early childhood

OBJECTIVE

To identify the impact of the Covid-19 pandemic on the use of digital screens in early childhood, from the perspective of mothers and education professionals.

METHOD

Qualitative study, based on Bronfenbrenner's Bioecological Theory. Nine mothers of children under three years of age, enrolled in daycare centers in a municipality in the state of Paraíba, Brazil, and six education professionals who worked in these daycare centers participated. The data were collected between July and October 2021 via virtual interviews and analyzed according to inductive thematic analysis.

RESULTS

The restrictions imposed by the pandemic made screens the only available resource for children's educational activities, interaction, leisure, and distraction, causing an exponential increase in the time they spent in front of screens.

CONCLUSION

The pandemic had a direct impact on the use of digital screens in early childhood, increasing the child's exposure time, according to parents and education professionals.

Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study

A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.

Complex care for children with chronic diseases from the perspective of care management

OBJECTIVE

To analyze the actions developed in hospitals for children with chronic diseases from the perspective of care management.

METHOD

Qualitative research, conducted with 14 health professionals from pediatric units in two northeastern hospitals, between November 2018 and March 2019, through semi-structured interviews. The empirical material was interpreted by thematic inductive analysis considering the care management construct.

RESULTS

The actions of the multi-professional team are fragmented, making it challenging to prepare and involve the family in care and not always responding to the child's unique and complex demands. The insufficient number of professionals, lack of material resources and inadequate infrastructure of hospital services reflect in the care practice, generating work overload and inadequate actions.

FINAL CONSIDERATIONS

Care management is an indispensable tool in coping with chronic childhood illnesses. The actions carried out by the multi-professional teams in hospitals must develop support to expand the care.

Structure of social networks of people living with HIV and AIDS

OBJECTIVE

To analyze the structure of the social network of people living with HIV and AIDS.

METHOD

Exploratory and descriptive research with a qualitative approach, developed through interviews with twenty-two people living with HIV and AIDS, from November to December 2019. For analysis, the theoretical-methodological framework of social network was used.

RESULTS

The primary networks were of medium size and low density, formed by family members, relatives, friends, neighbors, and colleagues. The secondary networks were characterized by public, private, third sector institutions, workplaces, and by the informal network, which provided support according to the need for care.

CONCLUSION

The family was considered the center of the primary social network structure; however, weaknesses in these social relationships were evidenced. The family relational context of the person with HIV and AIDS was influenced by the secrecy of the diagnosis due to the fear of prejudice and discrimination for being HIV-positive. There was a predilection for the services of the secondary social network that took on the role of specific care for the disease.

Professional Care in Home for Children and Teenagers with Special Health Needs: An Integrative Review

Objective: Analyzing the results of scientific publications on professional home care for children and teenagers with special health needs. Materials and method: An integrative review with articles published between 2009 and 2020 conducted in the BDEnf, Lilacs, Medline/PubMed databases and in the SciELO electronic library. The data were analyzed in four stages: data reduction; display of the data; comparison of data; drawing and verification of completion. Results: There were identified 5,641 articles; after the application of the inclusion and exclusion criteria and disposal of duplicates, 637 articles were chosen for the reading of titles and abstracts, of which 61 were selected for full reading and of these, 28 composed the final sample. The offer of remote support actions and concern in training caregivers regarding the technical-scientific aspects of home care was identified, in addition to promoting the improvement of the quality of life of children/teenagers and their families. A gap was evidenced regarding the identification and management of pain by home service professionals. Conclusions: The performance of home services to this specific population focuses on the demands of care with health technologies and on promoting symptom relief, reducing the workload of caregivers and assisting in dehospitalization.

Control del sobrepeso y la obesidad en niños y adolescentes por enfermeras: un estudio de métodos mixtos

Resumen Objetivo: analizar el manejo del sobrepeso y la obesidad en niños y adolescentes por las enfermeras de la Estrategia Salud de la Familia (ESF). Método: se trata de un estudio de método mixto paralelo convergente, desarrollado en Centros de Salud (UBS) de un municipio del nordeste de Brasil En la etapa cuantitativa, los datos fueron recolectados a partir de un cuestionario aplicado a 98 enfermeras y evaluados mediante estadística descriptiva. Para la etapa cualitativa, se realizaron entrevistas semiestructuradas con siete enfermeras, interpretadas por análisis temático inductivo. Se combinaron los resultados cuantitativos y cualitativos y se mostraron a través de joint display. Resultados: la mayoría de los enfermeros raramente verificaba el perímetro de cintura (77,6%), la dislipidemia (55,7%), la glucemia (42,3%) y tampoco evaluaba la presión arterial (75,3%). En los resultados cualitativos se identificó que hay enfermeras que no clasificaban el índice de masa corporal según sexo y edad. En cuanto a la solicitación de pruebas, las peticiones se trataban principalmente sobre la rutina asociada a la puericultura. Las orientaciones con respecto a la actividad física y nutrición se efectuaban de forma básica o eran asignadas a otros profesionales, y también no se hizo un seguimiento cuando fueron direccionados a otros servicios o profesionales. Conclusión: existen deficiencias en el conocimiento y la práctica de las enfermeras de atención primaria en el control del sobrepeso y la obesidad en niños y adolescentes. Es imperativo capacitar a los enfermeros para el manejo del sobrepeso y la obesidad en la atención primaria de niños y adolescentes, con miras a la calidad de la atención para la prevención de comorbilidades.

“A luta é nossa”: vivência de cuidadoras de crianças com síndrome congênita do Zika

Objetivou-se analisar a vivência de cuidadores de crianças com a síndrome congênita do Zika, no contexto familiar e social. Trata-se de um estudo qualitativo com dez cuidadoras de crianças com síndrome congênita do Zika vírus, em um serviço pernambucano de referência à criança com deficiência, realizado no período de novembro de 2018 a março de 2019. Os dados foram coletados por meio de entrevista semiestruturada e interpretados pela análise temática. As cuidadoras, principalmente mães, dedicam-se integralmente aos cuidados do filho com a síndrome; enfrentam lutas diárias em busca de melhores condições de vida; abdicam de sonhos, emprego e estudos; e enfrentam dificuldades financeiras e no cuidado a outros filhos. Assim, são necessárias ações de saúde focadas na singularidade das famílias para viabilizar a oferta e/ou fortalecimento de redes de apoio e ampliar as possibilidades para melhores condições de vida das mulheres e de seus filhos com a síndrome.

Atenção terciária à criança com doença crônica na perspectiva da gestão do cuidado

RESUMO Objetivo: Analisar as ações desenvolvidas na atenção terciária à criança com doença crônica na perspetiva da gestão do cuidado. Método: Pesquisa qualitativa realizada com 14 profissionais da saúde de unidades pediátricas de dois hospitais nordestinos, entre novembro de 2018 e março de 2019, por meio de entrevista semiestruturada. O material empírico foi interpretado por análise temática indutiva à luz da gestão do cuidado. Resultados: As ações das equipes multiprofissionais apresentam-se fragmentadas, dificultando o preparo e o envolvimento da família no cuidado e nem sempre respondendo às demandas singulares e complexas da criança. O número insuficiente de profissionais, falta de insumos e infraestruturas inadequadas dos serviços hospitalares refletem na prática assistencial gerando sobrecarga de trabalho e ações desarticuladas. Considerações finais: A gestão do cuidado contribui para a reestruturação dos processos de trabalho no hospital para que as ações da equipe atendam às demandas singulares e complexas dessa população.

Management of overweight and obesity in children and adolescents by nurses: a mixed-method study

Abstract Objective: to analyze the management of overweight and obesity in children and adolescents by nurses of the Family Health Strategy. Method: this is a study of convergent parallel mixed methods, developed in Health Centers of a municipality in northeastern Brazil. In the quantitative stage, data were collected from a questionnaire applied to 98 nurses and analyzed by descriptive statistics. For the qualitative stage, semi-structured interviews were conducted with seven nurses, interpreted by inductive thematic analysis. The quantitative and qualitative results were integrated and presented by a joint display. Results: most nurses rarely checked waist circumference (77.6%), dyslipidemia (55.7%), blood glucose (42.3%), and neither evaluated blood pressure (75.3%). In the qualitative results, we identified that there are nurses who did not classify body mass index according to sex and age. As for medical tests, the requests were mainly related to the routine of childcare. Guidance on physical activity and diet were given in a basic way or attributed to other professionals, and referrals to other services or professionals were not followed up. Conclusion: it is imperative to train nurses for the management of overweight and obesity in primary care for children and adolescents, with a view to quality of care for the prevention of comorbidities.

Nurse’s performance in the hospital discharge process of children with chronic disease

ABSTRACT Objective: To analyze the nurse’s performance in the hospital discharge process of children with chronic disease. Method: Qualitative research conducted from May to August/2019 with ten nurses working in a pediatric unit of a public hospital. The data, collected through semi-structured interviews, were submitted to inductive thematic analysis. Results: In the preparation for hospital discharge, nurses recognize health education as their attribution, valuing family knowledge in the training regarding home care. Nevertheless, their practice is weakened by the little articulation among the multiprofessional team, reduced nursing sizing and disarticulation in the health care network. Conclusion: There is a paradox between the report and the practice of the hospital discharge process accomplished by nurses. Although they have theoretical knowledge, their work process is influenced by the disarticulated way in which the multiprofessional team interacts, and the conditions provided by the institution to work in the preparation for hospital discharge of these children.

Melhor em casa: caracterização dos serviços de atenção domiciliar

RESUMO Objetivo caracterizar os Serviços de Atenção Domiciliar em funcionamento na Paraíba. Método trata-se de uma pesquisa descritiva, exploratória, de abordagem quantitativa. A coleta de dados foi realizada entre março e junho de 2020 com profissionais e coordenadores do Serviço de Atenção Domiciliar de 17 municípios paraibanos a partir da utilização de formulário no Google Forms enviado por correio eletrônico. Os dados foram analisados estatisticamente por meio de frequências absolutas e relativas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa. Resultados 14 equipes (61%) estavam em atividade de segunda a sexta-feira; 16 (69,6%) utilizavam o transporte assistencial compartilhado com outros serviços; 11 equipes (47,8%) não utilizavam prontuário eletrônico do paciente e, dentre as que utilizavam, o faziam no formato interligado à Rede de Atenção à Saúde ou em comunicação apenas com o Serviço de Atenção Domiciliar (34,8%; 17,4%). Quanto ao Projeto Terapêutico Singular, 13 equipes (56,5%) o elaboravam. O processo de referência e contrarreferência ocorria apenas na admissão e na alta em 19 equipes (82,6%). Conclusões e implicações para a prática evidenciou-se a necessidade de adequações no funcionamento do serviço e de melhorias nos recursos tecnológicos, comunicação e transporte a serem implementadas pela gestão pública para a qualificação da assistência domiciliar.

Atuação da enfermeira no processo de alta hospitalar de criança com doença crônica

RESUMO Objetivo: Analisar a atuação da enfermeira no processo de alta hospitalar de crianças com doença crônica. Método: Pesquisa qualitativa realizada de maio a agosto/2019 com dez enfermeiras de unidade pediátrica de hospital público. Os dados, coletados por meio de entrevistas semiestruturadas, foram submetidos à análise temática indutiva. Resultados: No preparo para alta hospitalar, as enfermeiras reconhecem como sua atribuição a educação em saúde, valorizando o saber familiar na capacitação quanto aos cuidados domiciliares. Entretanto, sua prática é fragilizada pela pouca articulação entre a equipe multiprofissional, dimensionamento de enfermagem reduzido e desarticulação na rede de atenção à saúde. Conclusão: Evidencia-se paradoxo entre o relato e a prática do processo de alta hospitalar efetivado pelas enfermeiras. Embora possuam conhecimento teórico, seu processo de trabalho sofre influência do modo desarticulado como a equipe multiprofissional interage e das condições disponibilizadas pela instituição para atuarem no preparo para alta hospitalar dessas crianças.

It is better at home: characterization of home care services

ABSTRACT Objective to characterize the Home Care Services in operation in Paraíba. Method this is a descriptive, exploratory, quantitative research. Data collection was conducted between March and June 2020 with professionals and coordinators of Home Care Services in 17 municipalities of Paraiba using Google Forms sent by email. Data were statistically analyzed using absolute and relative frequencies. The project was approved by the Research Ethics Committee. Results 14 teams (61%) were active from Monday to Friday; 16 (69.6%) used transportation of care shared with other services; 11 teams (47.8%) did not use electronic patient records and, among those who did, they did so in the format interconnected to the Health Care Network or in communication only with the Home Care Service (34.8%; 17.4%). As for the Singular Therapeutic Project, 13 teams (56.5%) prepared it. The reference and counter-reference process occurred only at admission and discharge in 19 teams (82.6%). Conclusions and implications for the practice it was evidenced the need for adjustments in the operation of the service and improvements in technological resources, communication and transportation to be implemented by public management for the qualification of home care.

“The fight is ours”: the experience of caregivers of children with congenital zika syndrome

The study analyzed the experience of caregivers of children with congenital zika syndrome, both in family and social context. It is a qualitative study with ten caregivers of children with congenital zika virus syndrome, in a Pernambuco referral service for children with disabilities, from November 2018 to March 2019. Data were collected through semistructured interviews and interpreted by thematic analysis. Caregivers, especially mothers, dedicate themselves entirely to their syndromic children’s care, facing daily struggles in search of better living conditions, abandoning dreams, jobs, studies and facing financial difficulties as well as for the care of other children. Thus, health actions focused on the uniqueness of families are necessary to enable the offer and / or strengthening of support networks as well as to expand the possibilities for better living conditions for both women and their children with the syndrome.

The family of the child with special health care needs and their social relationships

ABSTRACT Objectives: to identify aspects that can influence the types of bonds developed in the social support network of family members of children with special health care needs. Methods: qualitative research conducted through interviews with 15 family members/guardians in the city of Rio de Janeiro, from January to February 2020. Sanicola’s theoretical-methodological framework and Bardin’s thematic analysis technique were used. Results: social distancing, lack of responsibility for coordinating care, lack of supplies and lack of individualized care were weaknesses found in the families’ social relationships. However, the bonds were strengthened by the relationship of familiarity and availability of professionals in the care of children with special health needs. Final Considerations: understanding the configuration of primary and secondary social networks and the types of support offered can improve the care of children and strengthen bonds that provide security for families.

Manejo do sobrepeso e obesidade em crianças e adolescentes por enfermeiras: estudo de métodos mistos

Resumo Objetivo: analisar o manejo do sobrepeso e da obesidade de crianças e adolescentes por enfermeiras da Estratégia Saúde da Família. Método: estudo de método misto paralelo convergente, desenvolvido em Unidades Básicas de Saúde, de um município do nordeste brasileiro. Na etapa quantitativa, os dados foram coletados a partir de um questionário aplicado a 98 enfermeiras e analisados por meio de estatística descritiva. Para a etapa qualitativa, foram realizadas entrevistas semiestruturadas com sete enfermeiras, interpretadas pela análise temática indutiva. Os resultados quantitativos e qualitativos foram integrados e apresentados por meio de joint display. Resultados: a maioria dos enfermeiros raramente verificava a circunferência da cintura (77,6%), dislipidemia (55,7%), glicemia (42,3%) e nenhum avaliava a pressão arterial (75,3%). Nos resultados qualitativos, identificamos que há enfermeiros que não classificavam o índice de massa corporal segundo sexo e idade. Quanto aos exames, as solicitações estavam relacionadas principalmente à rotina de puericultura. As orientações sobre atividade física e alimentação foram dadas de forma básica ou atribuídas a outros profissionais, e os encaminhamentos para outros serviços ou profissionais sem seguimento pelos enfermeiros. Conclusão: é imperioso a capacitação dos enfermeiros para o manejo do sobrepeso e obesidade na atenção primária para crianças e adolescentes com vistas a qualidade do atendimento para a prevenção de comorbidades.

Self-management support of adolescents with type 1 Diabetes Mellitus in the light of healthcare management

OBJECTIVES

to analyze the self-management support needs of adolescents with type 1 diabetes mellitus.

METHODS

this qualitative research was carried out between September and December 2017 with nine adolescents in the pediatric outpatient clinic of a university hospital and in their homes. The material collected through semi-structured interviews was interpreted by thematic inductive analysis in the light of the healthcare management concept.

RESULTS

adolescents' self-management support needs include longitudinal monitoring by health teams; family support in their training; support from the social network; and a careful look by government officials in the construction of guidelines for dispensing the essential inputs for treatment. However, these needs are not always met satisfactorily, resulting in gaps in this support.

FINAL CONSIDERATIONS

these gaps interfere in resolving health demands. Self-care with fragmented support affects the healthcare management dimensions, making it impossible to meet the uniqueness of adolescents in a comprehensive, expanded and ethical way.

Ideal time for home visits to newborns: an integrative review

This study aimed to analyze in the scientific production in online journals regarding the ideal time to conduct home visits (HVs) to newborns (NBs) in their first week of life, and the difficulties in doing so due to the lack of a consensus around the subject. This is an integrative review based on data available on the MEDLINE, BVS, Web of Science and PubMed databases. Eight studies published between 2010 and 2015 were identified. The thematic analysis evidenced two topics, namely, the ideal time for the first home visit to the newborn, and difficulties in implementing the home visit to the newborn in the first week of life. The results suggest that the first visits should take place in the first week of life, especially within the second day after birth. However, some impediments to the realization of the home visit are found, such as geographical barrier, poor quality of care delivered by professionals, low number of notifications of mother-baby binomial hospital discharge, and mothers' lack of knowledge about the relevance of postnatal care. All this can impair the performance of health professionals, and requires investing in their professional qualification and service infrastructure.

Continuity of neuro-psychomotor stimulation of children with congenital Zika syndrome

OBJECTIVE

Understand the continuity of stimulation of neuro-psychomotor development in children with congenital Zika syndrome.

METHOD

Descriptive-exploratory study with theoretical support in symbolic interactionism. Between August and November 2019, 12 health professionals were interviewed in depth; and to the focus group, seven caregivers of children with the syndrome. The analysis was thematic inductive.

RESULTS

The continuation of neuro-psychomotor stimulation of children with Zika syndrome goes through: organizational difficulties (lack of doctors, professional unpreparedness, dissatisfaction and search for other services); socioenvironmental aspects (low maternal education, low socioeconomic level, difficulty in moving and lack of support); and conditions inherent to children (hospitalizations for respiratory crises, seizures, hypoactivity and social stigma).

FINAL CONSIDERATIONS

A strengthened support network with qualified human resources is necessary in order to provide comprehensive care and avoid the discontinuity of neuro-psychomotor stimulation of children with congenital Zika syndrome.

Aleitamento materno na experiência de mães de crianças traqueostomizadas e o uso da válvula Passy-Muir®

Resumo Objetivo compreender a experiência de mães de crianças traqueostomizadas, entre 0 e 24 meses de idade, que retomaram o aleitamento materno com o uso de válvula de deglutição Passy-Muir®. Método pesquisa descritiva, de natureza qualitativa, com 11 mães de crianças traqueostomizadas que adaptaram a válvula de deglutição Passy-Muir®, acompanhadas em um centro de reabilitação e fonoaudiologia, mediante entrevistas semiestruturadas, nos meses de junho a agosto de 2017. A análise foi fundamentada nos pressupostos da análise de conteúdo temática. Resultados na experiência das mães, após a traqueostomia da criança, o uso da válvula de deglutição Passy-Muir® minimizou as dificuldades no aleitamento materno. Superado o processo de adaptação da válvula, foram percebidos seus benefícios. São descritos os sentimentos das mães nesse processo, suas expectativas quanto ao uso do dispositivo e o prazer e plenitude para a mulher no retorno do aleitamento materno. Conclusões e implicações para a prática observaram-se segurança ao aleitar, menor produção de secreção, reduções no número de aspirações de vias áreas, melhora no padrão respiratório, vocalizações (balbucios e choro), melhora na qualidade do sono da criança. Novas pesquisas que abordem o aleitamento materno de crianças traqueostomizadas são necessárias para aprofundar conhecimentos nesta área.

First aid intervention with mothers/caregivers of children affected by the Zika virus in Brazil

BACKGROUND

Children with microcephaly associated with the Zika virus are more likely to develop choking and apnea, so it is necessary that mothers of this population receive first aid training to cope with emergency situations that their children may experience.

OBJECTIVE

To understand how an educational first aid intervention with mothers/caregivers of Brazilian children with congenital Zika virus syndrome impacts their management of seizures and choking.

METHOD

A qualitative study conducted in a philanthropic institution with ten mothers/caregivers of children with congenital Zika virus syndrome. Data were collected between August and November 2018 through four focus groups with two meetings for intervention/educational workshops in first aid on situations of choking and seizure. After one month, two more meetings were held to evaluate the effectiveness of this action performed at home. The empirical material was submitted to Content Analysis, and discussed in the light of Paulo Freire's Pedagogy of Autonomy.

RESULTS

The mothers/caregivers performed ineffective and harmful behaviors to the children in situations of choking and seizure before the intervention. Thus, the intervention empowered these caregivers through an exchange of experiences which began to present discernment, autonomy, resolving capacity and confidence to act in these experienced situations. They also became knowledge disseminators for family members and neighbors.

CONCLUSION

The educational intervention can have satisfactory results in training mothers/caregivers in first aid, highlighting the importance of this initiative to reduce the morbidity and mortality of children who experience choking and seizures.

Nurses' perception on social network of children with chronic illness: qualitative study, Brazil

Introduction

The high prevalence of chronic diseases in childhood is a serious public health problem in Brazil. The family life of children with chronic illness is marked by numerous determinant and conditioning factors, whether they are biological, psychological, cultural and social. Such factors are more relevant in the absence of a social support network for care. Therefore, the greater the support offered by health professionals, the greater the resources available for the family to face vulnerability.

Objectives

describing primary care nurses' perception of the social network approach for children with chronic diseases.

Methods

Qualitative research conducted in October 2019 through an interview with ten nurses from family health units in the city of Rio de Janeiro, Brazil. The project was approved by the Ethics and Research Committees of the participating institutions. Thematic content analysis was used.

Results

For nurses, social network meant support from family members and from secondary and tertiary level services. In their practice, these professionals are often unaware of the health situation of children with chronic diseases, and they perceive lack of articulation in referral those children to other services of the Health Care Network.

Conclusions

There are gaps between knowledge and practice of these professionals on the social network approach. It is important to highlight frailties in comprehensive care of children with chronic illness and the service counter-referral to the family health unit. It is necessary to carry out training courses for professionals, helping them to belong to the social network of the family of the child with chronic disease. This strategy could implement effective approach of support, surveillance and health promotion of children.

Key messages

There is a gap in the knowledge of social network approach among primary care nurses. The social network approach of children with chronic diseases favors comprehensive care and implementation of effective strategies focused on supporting, monitoring and promoting child health.

Gestão do Diabetes Tipo 1: necessidades de autocuidado apoiado na transição para adolescência

Analisar as necessidades de autocuidado apoiado para a gestão do diabetes tipo 1 na transição da infância para adolescência. Pesquisa qualitativa mediada pela entrevista semiestruturada com nove pré-adolescentes atendidos em ambulatório e Unidades de Saúde da Família da Paraíba entre setembro/dezembro de 2016. Os dados foram interpretados pela análise temática. Os pré-adolescentes necessitam além do conhecimento para o manejo e a gestão da doença nos espaços que frequenta cotidianamente, do apoio da família e da rede social na transição do cuidado. A equipe multiprofissional de saúde não tem utilizado o autocuidado apoiado singular na gestão do diabetes e a da atenção primária não tem acolhido suas necessidades, fragilizando vínculos com a rede de cuidados. As necessidades para o autocuidado no diabetes versam sobre conhecimento da doença, e as relações estabelecidas com a rede de apoio social como a família, equipe multiprofissional e a escola.

Stimulation of children with congenital Zika syndrome at home: challenges for the caregivers

OBJECTIVE

To identify the challenges faced by caregivers regarding the stimulation of the development of children with congenital Zika syndrome at home.

METHOD

A qualitative study was carried out with ten caregivers of children with the syndrome and five health professionals who work in a specialized service of reference for children/adolescents with disabilities in a city in Pernambuco, Brazil. Data collection took place between November 2018 and March 2019 through a semi-structured interview, and the data were interpreted using thematic analysis.

RESULTS

The challenges faced by caregivers are permeated by fear, insecurity and lack of support for the realization of the stimulatory activities at home. Practitioners acknowledge the situation but emphasize the importance of continuing the stimulatory activities to preserve the capabilities of these children.

CONCLUSIONS

It is necessary to sensitize health teams to support families regarding the challenges faced and provide full time care for the child with Zika syndrome in order to achieve maximum development.

Avaliação em saúde: dimensão processual e estrutural da saúde da criança na atenção primária

RESUMO O estudo teve como objetivo avaliar os atributos da dimensão processual e estrutural da atenção primária à saúde da criança em dois modelos de atenção à saúde. Estudo quantitativo, realizado com dados secundários de estudo multicêntrico, com cuidadores de crianças em unidades de saúde da família e unidades de atenção básica tradicional, de dois municípios de médio porte brasileiros, cuja coleta de dados ocorreu em 2012 e 2013. O Primary Care Assessment Tool (PCATool-Brasil) versão criança foi utilizado para a avaliação da efetividade dos modelos. Análise estatística inferencial. Na avaliação dos atributos essenciais, o escore médio foi igual ou superior ao esperado (6,6) e o escore geral ficou abaixo (6,4). Na perspectiva do cuidador da criança, os dois modelos de atenção estão orientados à atenção primária apenas nos atributos essenciais, porém, não no escore geral. As fragilidades e potencialidades dos modelos de atenção indicam a necessidade de mudanças na organização dos serviços para contemplar o cuidado integral à criança.

Social network of children with cronic disease: knowledge and practice of nursing

OBJECTIVES

To identify the knowledge and practice of primary care nurses about the social network approach for families of children with chronic diseases.

METHODS

Qualitative research, conducted by means of interviews with 23 family health nurses, from one municipality in Paraíba and one in Rio de Janeiro, from June to July of 2017. The data were interpreted using thematic analysis.

RESULTS

Social network meant institutional support offered by services outside the unit, and socioeconomic problems involved the family context. In practice, nurses find it difficult to provide comprehensive care and establish ties with families. When referring to other professionals, a weakness in the counter-referral to the family health unit is found.

FINAL CONSIDERATIONS

Some gaps were found regarding the knowledge and practice of nurses regarding the social network approach, which requires professional training to strengthen social relationships and the necessary support for families of children with chronic diseases.

Itinerário da criança com microcefalia na rede de atenção à saúde

RESUMO Objetivos investigar o itinerário terapêutico de crianças com microcefalia associada ao Zika na rede de atenção à saúde; e descrever a vivência das mães em relação ao itinerário percorrido para o tratamento de seus filhos. Método Estudo norteado pela História Oral Temática, realizado em instituição pública filantrópica do município de João Pessoa-Paraíba. Foram entrevistadas dez mães de crianças com microcefalia entre abril e agosto de 2017. O material empírico foi submetido à análise de conteúdo temática. Resultados Os profissionais de saúde têm dificuldade para definir o diagnóstico de crianças com microcefalia, e se encontram despreparados para informá-lo aos pais, comprometendo o itinerário terapêutico dessas crianças. As experiências das mães em busca de tratamento para seus filhos são marcadas por estresse, medo, decepção e pela frágil rede de apoio familiar, resultando em sobrecarga materna. Conclusão e implicações para a prática A reestruturação dos fluxos e contrafluxos da Rede de Atenção à Saúde às crianças com microcefalia e seus familiares torna-se imprescindível, assim como, o fortalecimento da rede de apoio às mães.

Challenges in Primary Care Regarding Children and Adolescents With Chronic Conditions in Brazil

The coordination of primary care is pivotal to the management of chronic conditions. However, current systems may not be as efficient or effective as one would hope. This article addresses to the managers and health teams in the primary care setting and their challenges regarding children and adolescents with chronic conditions in Brazil. A qualitative study was conducted with 26 primary care professionals and managers using thematic content analysis. The results showed a scarcity of specialists for referrals and a lack of professional training for dealing with this specific group of patients. It is necessary to improve health information systems to ensure the continuity of care. Current health care of children and adolescents with chronic conditions is neither efficient nor effective. For this type of care to be comprehensive, the health needs of this population must be addressed and the operational structure of the health care network must be strengthened.

Effectiveness of an intervention with mothers to stimulate children under two years

OBJECTIVE

To analyze the effectiveness of an educational intervention with mothers to stimulate children under two years of age at risk for neuropsychomotor development.

METHOD

Before-after intervention study, conducted with 52 mothers of children under two years old, enrolled in reference centers in early childhood education. Initially, maternal knowledge regarding child development and stimulation was assessed through a structured instrument. Then, workshops were held with the mothers and, after three months, maternal knowledge was revised, reapplying the data collection instrument. In the analysis, descriptive and inferential statistics were used, applying the McNemar and Wilcoxon tests and the Rasch Model from the Item Response Theory.

RESULTS

after the intervention, there was a significant increase in scores regarding the following aspects: knowledge of mothers about child development and stimulation from 5.77 ± 1.85 to 18.60 ± 1.94 (p <0.001); reduction of the maternal difficulty index in answering the instrument questions from 1.17 ± 0.57 to -1.98 ± 1.63 (p 0.01).

CONCLUSION

the educational intervention contributed to the improvement of maternal knowledge regarding the development and forms of child stimulation, corroborating the importance of this action to advance the health of children at risk under maternal care at home.

VIVÊNCIAS SINGULARES DE PROFISSIONAIS DE SAÚDE NA REDE E APOIO SOCIAL À CRIANÇA COM PARALISIA CEREBRAL

Objetivo: compreender as vivências dos profissionais de saúde na rede e apoio social à criança comparalisia cerebral.Metodologia: estudo descritivo, qualitativo, realizado com oito mães e uma avó em clínica escola einstituição à pessoa com deficiência, de outubro de 2015 a maio de 2016, por meio de entrevistasemiestruturada. Interpretação balizada pela análise temática e fundamentada nos conceitos deEmmanuel Lévinas.Resultados: é comum estresse dos profissionais afetando a relação equipe-criança e família,gerando desconfiança e falta de compromisso entre estes. Deposita-se confiança nos profissionaisde reabilitação e há fragilidade na relação com profissionais da Estratégia Saúde da Família.Conclusão: as vivências dos profissionais de saúde na rede e apoio social à criança com paralisiacerebral demonstram que esses devem respeitar as situações em que o Outro está enredado, demodo a ajustar as metas do tratamento de acordo com a necessidade do Outro.

SUPPORTED SELF-CARE ACTIONS FOR CHILDREN AND TEENAGERS WITH CHRONIC DISEASES

ABSTRACT Objective: to analyze actions of Primary Health Care teams from the perspective of supported self-care for children and adolescents with chronic diseases. Method: a qualitative study, conducted between April and August 2016, with 11 primary care professionals from a municipality of Paraíba, Brazil. A semi-structured interview supported data collection; and a thematic analysis backed interpretation, which categorized the actions according to the 5 A ́s methodology (Evaluation, Guidance, Agreement, Assistance, Follow-up). Results: there were insufficient actions in the specific care plans. Isolated interventions are performed including: assessment of barriers to self-care and emotional state of the individual; provision of information on signs, symptoms of disease and treatment; stimulating the search for community resources; actions inherent to professional training; and follow-up by active search and home visits. Conclusions: actions in Primary Health Care do not yet value the active and co-responsible role of the individual in the control of their disease, with gaps to be overcome in the five pillars of supported self-care. Intervention studies are recommended that train professionals regarding supported self-care of these individuals.

Ações Implementadas por Enfermeiros na Consulta de Puericultura: revisão integrativa da literatura

Objetiva-se evidenciar as ações implementadas por enfermeiros na consulta de puericultura e analisá-las à luz das Diretrizes Brasileiras de Atenção à Saúde da Criança. Trata-se de uma revisão integrativa realizada nas bases de dados: LILACS, PubMed, Web of Science e BDENF. Foram selecionados 23 artigos e três Diretrizes Brasileiras de Atenção à Saúde da Criança do Ministério da Saúde brasileiro. Evidenciaram-se duas áreas temáticas: ações para a promoção da saúde e prevenção de doenças, cuja avaliação antropométrica constituiu-se como ação mais efetivada, e ações relacionadas ao tratamento de agravos, configurando-se o encaminhamento das crianças para especialidades a ação mais realizada pelo enfermeiro. Conclui-se que a prática do enfermeiro não atende ao preconizado pelas diretrizes brasileiras, e apesar da consulta de puericultura ser uma ferramenta potente para o cuidado integral, apresenta-se fragmentada e com lacunas que podem comprometer a saúde da criança. Palavras-chave: Cuidado da Criança; Enfermagem; Atenção Primária à Saúde; Enfermeiro. Abstract The study aims to highlight the actions implemented by nurses in the childcare consultation and to analyze them in the light of the Brazilian Guidelines for Child Healthcare. This is an integrative review carried out in the databases: LILACS, PubMed, Web of Science and BDENF. Were selected 23 articles and three Brazilian Guidelines for Child Healthcare from the Brazilian Ministry of Health. There were two thematic areas: actions for health promotion and disease prevention, whose anthropometric evaluation constituted as more effective action, and actions related to the injuries treatment, configuring the children referral to specialties the most accomplished action by the nurse. It is concluded that the nurses’ practice does not meet the requirements of Brazilian guidelines, and although the childcare consultation is a powerful tool for the comprehensive care, it is fragmented and has gaps that can compromise the child's health. Keywords: Childcare; Nursing; Primary Healthcare; Nurse.

A PRÁTICA DO ENFERMEIRO NA CONSULTA DE PUERICULTURA NA ESTRATÉGIA SAÚDE DA FAMÍLIA

RESUMO Objetivo: analisar as ações de cuidado realizadas pelo enfermeiro durante as consultas de puericultura. Método: estudo observacional, quantitativo, realizado com 31 enfermeiros que realizavam consulta de puericultura na Estratégia Saúde da Família de um município da Paraíba (Brasil). Foram observadas três consultas aleatórias por cada enfermeiro participante, totalizando 93 consultas entre março e julho de 2016, por meio de um checklist previamente estruturado, baseado nas diretrizes das políticas nacionais de atenção à saúde da criança, contendo as ações de cuidados que deveriam ser implementadas pelos enfermeiros. A análise foi feita por meio de estatística descritiva, teste qui-quadrado, com nível de significância de 5% e análise de agrupamento. Resultados: as dimensões do cuidado realizadas em maior proporção foram a avaliação da imunização e as suplementações de ferro e vitamina A; a anamnese, o acolhimento, o exame físico/desenvolvimento neuropsicomotor e a educação em saúde foram as menos efetivadas pelos enfermeiros. Conclusão: o cuidado dos enfermeiros na consulta de puericultura está aquém do estabelecido pelas diretrizes de atenção à saúde da criança. Ações de educação permanente para qualificar os enfermeiros para o cuidado integral à criança podem superar essas lacunas.

Self-care support for the management of type 1 diabetes during the transition from childhood to adolescence

ABSTRACT Objective: To analyze the needs of pre-adolescents with type 1 diabetes regarding self-care support for disease management. Method: Qualitative study conducted between October and December 2016 with pre-adolescents seen at a hospital outpatient clinic and at Family Health Units; semi-structured interviews were used. Data were analyzed using a thematic analysis based on the theoretical basis of self-care support. Results: Nine pre-adolescents participated in the study. It was identified that in order to build self-efficacy, pre-adolescents need to overcome the disease denial phase, know how to handle feelings triggered by the need for lifestyle changes, receive support from their families and social networks, and have the self-awareness and self-perception needed to feel secure in managing their diabetes. Conclusion: The intrinsic challenges of adolescence and the way pre-adolescents with diabetes handle the disease have an influence on diabetes management and create needs that must be appreciated by health care professionals in order to provide self-care support.

Governança e suporte da rede social secundária na atenção à saúde de crianças e adolescentes com doenças crônicas

Resumo Estudo de abordagem qualitativa com o objetivo de analisar as características estruturais dos sistemas de governança e suporte ofertado pela rede social secundária na atenção à saúde de crianças e adolescentes com doença crônica. Pesquisa realizada em unidades da Estratégia Saúde da Família, ambulatório especializado e hospital público pediátrico de João Pessoa - PB, de fevereiro a outubro de 2013, por meio de entrevista semiestruturada e grupo focal. Participaram do estudo: 06 gestores, 14 profissionais de saúde e 12 familiares cuidadores de crianças ou adolescentes com doenças crônicas. Os dados foram analisados seguindo-se os princípios da análise temática de conteúdo. Na atenção à saúde das crianças e adolescentes com doenças crônicas evidenciou-se o sistema de governança do tipo colaborativo, bem como limitações da governança pública do tipo gerencial, que fragilizam a rede social secundária com repercussões no suporte oferecido aos familiares e na articulação entre os serviços. Conclui-se que essa realidade pode apresentar impacto negativo na qualidade e efetividade do cuidado prestado às crianças e adolescentes em condição crônica, por não atender as reais necessidades dessa população.

Doença crônica infantojuvenil: vínculo profissional-família para a promoção do apoio social

Resumo OBJETIVO Analisar o vínculo na promoção do apoio social ofertado pela equipe multiprofissional de saúde às famílias durante a hospitalização de crianças/adolescentes com doença crônica. MÉTODO Pesquisa qualitativa, realizada em unidade pediátrica de um hospital público da Paraíba, de novembro de 2012 a julho de 2013, com quatorze profissionais de saúde, por meio de entrevista semiestruturada. A interpretação dos dados foi mediada pela análise temática. RESULTADOS O vínculo equipe-família é promovido pelo diálogo e escuta, reconhecidos como fontes de apoio social. Evidenciaram-se dificuldades como a fragilidade na comunicação e interação entre equipe-família; lacunas na organização do processo de trabalho e falta de infraestrutura hospitalar, que interferem na oferta de apoio. Como caminhos para superar os obstáculos, evidenciou-se o seguimento após alta e fortalecimento do vínculo equipe-família. Conclusões: O apoio social satisfatório influencia o enfrentamento da doença crônica infantojuvenil e, para sua oferta, o vínculo e o acolhimento são indispensáveis.

First week of integral health for the newborn: nursing actions of the Family Health Strategy

OBJECTIVE

To describe the nurses' actions of the Family Health Strategy about the First Week for Integral Health regarding the care devoted to the newborn.

METHOD

It is a descriptive, exploratory research with qualitative approach carried out from October 2014 to February 2015, through a semi-structured interview, with nine nurses from the Family Health Strategy of João Pessoa-PB. Data were submitted to thematic analysis.

RESULTS

The actions identified at the first visit to the newborn child are based on maternal guidance on basic newborn care, breastfeeding, neonatal screening, immunization and childcare, as well as evaluation of the puerperal, but it was sometimes performed outside the period recommended and with incomplete and outdated guidelines.

CONCLUSION

Although there are potentialities in nurses' actions to this population, the fragilities compromise the care of the newborn and the puerperium, and it is necessary to sensitize these professionals about the importance and effectiveness of First Week for Integral Health.

Doubling immunochemistry laboratory testing efficiency with the cobas e 801 module while maintaining consistency in analytical performance

OBJECTIVES

The new immunochemistry cobas e 801 module (Roche Diagnostics) was developed to meet increasing demands on routine laboratories to further improve testing efficiency, while maintaining high quality and reliable data.

DESIGN AND METHODS

During a non-interventional multicenter evaluation study, the overall performance, functionality and reliability of the new module was investigated under routine-like conditions. It was tested as a dedicated immunochemistry system at four sites and as a consolidator combined with clinical chemistry at three sites.

RESULTS

We report on testing efficiency and analytical performance of the new module. Evaluation of sample workloads with site-specific routine request patterns demonstrated increased speed and almost doubled throughput (maximal 300 tests per h), thus revealing that one cobas e 801 module can replace two cobas e 602 modules while saving up to 44% floor space. Result stability was demonstrated by QC analysis per assay throughout the study. Precision testing over 21 days yielded excellent results within and between labs, and, method comparison performed versus the cobas e 602 module routine results showed high consistency of results for all assays under study. In a practicability assessment related to performance and handling, 99% of graded features met (44%) or even exceeded (55%) laboratory expectations, with enhanced reagent management and loading during operation being highlighted.

CONCLUSION

By nearly doubling immunochemistry testing efficiency on the same footprint as a cobas e 602 module, the new module has a great potential to further consolidate and enhance laboratory testing while maintaining high quality analytical performance with Roche platforms.

DOENÇA CRÔNICA NA INFÂNCIA E ADOLESCÊNCIA: VÍNCULOS DA FAMÍLIA NA REDE DE ATENÇÃO À SAÚDE

RESUMO Objetivo: explicitar como se constroem os vínculos entre a família da criança/adolescente com doença crônica e os diferentes serviços da rede de atenção à saúde, tendo a Atenção Primária à Saúde como o centro organizador do cuidado. Método: estudo de abordagem qualitativa, realizado com dez familiares de crianças/adolescentes com diagnóstico de doença crônica entre maio e novembro de 2015. Para produzir o material empírico, utilizaram-se o mapa falante e o ecomapa, ambos adaptados neste estudo, em seus domicílios, localizados na área de abrangência de Unidades de Saúde da Família e na própria Unidade de Saúde da Família, conforme preferência de um familiar. Posteriormente, foram realizadas doze entrevistas semiestruturadas com profissionais de serviços da rede de atenção à saúde do município - duas Unidades de Saúde da Família e dois hospitais públicos. Os dados foram interpretados com base na análise de discurso de linha francesa. Resultados: o sentido de vínculo está relacionado à atenção dispensada pelos profissionais de saúde. A atenção explicitada nas marcas textuais analisadas é um conceito base, que pode ser parafraseado em seus vários sentidos, como: acessibilidade, resolutividade, responsabilização, humanização, empatia e expectativa satisfeita. Conclusão: é preciso que cada ponto de atenção da rede assistencial buscado pela família lhe seja uma referência ampla, concreta e duradoura, especialmente a Atenção Primária à Saúde, que deve cumprir seu papel de coordenadora do cuidado e fonte cuidadora.

Quality of life related to health of adolescents with dm1: an integrative review

This study aimed to analyze the scientific literature on health-related quality of life (HRQOL) of adolescents with type 1 diabetes mellitus. This is an integrative review whose inclusion criteria were full-text papers available online in Portuguese, English and Spanish; published and indexed in databases Lilacs, Medline, Adolec, BDENF, in the period 2003-2013 that reflected the theme HRQOL, Type 1 diabetes and adolescents. Twenty-two papers were analyzed, from which the following themes were retrieved: development and validation of tools to measure the HRQOL of diabetic adolescents; HRQOL of adolescents with diabetes; factors affecting the quality of life of adolescents with diabetes and resources used to assist adolescents in diabetes management. The HRQOL of adolescents with diabetes has been a widely studied and disseminated topic in international literature, but has poorly echoed in Brazil. Studies published in international journals in English predominated. Thus, we emphasize the importance of conducting research of this nature in Brazil, since the measurement of HRQOL of diabetic adolescents may help the multidisciplinary team in care planning.

Paternal care to children and adolescent with chronic disease: maternal perception

OBJECTIVE

To analyze the maternal perception about the paternal care and to understand how this care Is made effective In practical actions in the care of the child/adolescent with chronic disease in the family routine.

METHODS

Exploratory-descriptive, qualitative study, carried out at the pediatric outpatient clinic of a public hospital in the state of Paraíba, between November/2013 and April/2014, with 10 mothers whose children had more than six months of diagnosis. Semi-structured interview subsidized the data collection, which was submitted to thematic analysis.

RESULTS

Parents participated in activities such as routine care of the child, medication management, leisure, binomial support and household chores. They took on different roles in the care depending on the availability of time and the maternal freedom given for their participation. Among the separated couples, the distance between parents in the care reflected on the child's health.

CONCLUSION

It is important to involve fathers in the care of the child with chronic diseases. However, there is a need for a greater involvement of fathers in the performance of this care.

Vivência de adolescentes com diabetes mellitus na perspectiva da ética da alteridade

Resumo Objetivo Conhecer a vivência de adolescentes com diabetes mellitus tipo 1 na perspectiva da Ética da Alteridade. Métodos Estudo exploratório-descritivo com abordagem qualitativa realizado de fevereiro a outubro de 2016, com nove adolescentes por meio de grupos focais e entrevistas semiestruturadas. Os dados foram submetidos à análise temática, e as reflexões norteadas na perspectiva da Ética da Alteridade. Resultados Foram construídas as seguintes categorias: A descoberta do diagnóstico e convivendo com o diabetes. Desde o diagnóstico, os pais assumiram a responsabilidade pelo cuidado aos filhos, e, na perspectiva da Ética da Alteridade, estiveram presentes e abertos para acolhê-los enquanto Outro. Os adolescentes demonstraram ser pessoas confiantes com autoestima preservada, mesmo diante do enfrentamento de situações adversas que interferem no manejo da doença, dentre elas a restrição da dieta e a falta de insumos. A condição da hipoglicemia e hiperglicemia foram eventos comuns entre eles, e o método de contagem de carboidratos foi apontado como ótimo recurso na aceitabilidade da doença. A independência tão almejada pelos adolescentes esteve condicionada à capacidade de autocuidado. Os adolescentes referiram manter um ótimo relacionamento com a família, amigos e equipe multiprofissional, o que tem favorecido a aceitação da doença. Conclusão O respeito à Alteridade do Outro pelo Eu é imperativo nas relações de cuidar implementadas pela família; pelos amigos, pela equipe multiprofissional e pelo Estado, como forma de resgatar a dignidade de adolescentes com diabetes.