Educational technology to promote father involvement in childbirth and birth

OBJECTIVES

to build and validate an educational booklet to promote the involvement of parents in labor and birth.

METHODS

methodological study developed in five stages: situational diagnosis; bibliographic survey; construction of illustrations, layout, design and texts; content and appearance validation by judges (25 experts) and calculation of the Flesch Readability Index; and validation with the target audience (12 parents). A minimum Content Validity Index of 0.80 was considered.

RESULTS

the booklet was entitled "Father Presence" and was developed in 11 topics. In Content and Appearance Validation, the Validity Index obtained an overall score of 0.97. Cronbach's alpha was 0.92, indicating excellent reliability of its content. A global score of 74% for readability was obtained, considered easy to understand.

CONCLUSIONS

the material was successful in the validation process, and it can be recommended for parents to use it during the prenatal period, promoting the inclusion of the partner and preparing them for labor and birth.

Tecnologia educacional para promoção do envolvimento de pais no parto e nascimento

RESUMO Objetivos: construir e validar uma cartilha educativa para promoção do envolvimento de pais no parto e nascimento. Métodos: estudo metodológico desenvolvido em cinco etapas: diagnóstico situacional; levantamento bibliográfico; construção das ilustrações, layout, design e textos; validação de conteúdo e aparência por juízes (25 especialistas) e cálculo do índice de Legibilidade de Flesch; e validação com o público-alvo (12 pais). Considerou-se Índice de Validade de Conteúdo mínimo de 0,80. Resultados: a cartilha intitulou-se “Presença de pai” e foi desenvolvida em 11 tópicos. Na validação de conteúdo e aparência, o Índice de Validade obteve escore global de 0,97. O alfa de Cronbach foi 0,92, indicando excelente confiabilidade de seu conteúdo. Pontuação global para legibilidade foi 74%, denotando fácil compreensão. Conclusões: o material teve êxito no processo de validação, podendo ser recomendado para os pais utilizarem-no durante o período pré-natal, promovendo a inclusão do parceiro e preparando-os para o parto e nascimento.

Profile of women affected with premature childbirth and neonatal outcomes

Abstract Objectives: to describe the profile of women affected with premature childbirth and neonatal outcomes at a referral maternity in the city of Fortaleza-CE, Brazil. Methods: descriptive and retrospective documentary type study, with a quantitative approach, carried out from January to December, 2017, with 253 medical records of women who had premature childbirth in a referral maternity. Results: the average age was 28, with the prevalence of women living in a stable union, graduated from high school and without formal work. The gestational mean average was three pregnancies, gestational age of 34 weeks and three days, and six prenatal consultations, starting in the first trimester. The major intercurrence was pre-eclampsia. In relation to the neonatal data, there was a prevalence of male newborns, with an average of 2.251 kg and a score of seven on the 1-minute Apgar and eight on the 5-minute Apgar. Newborns in going to a hospital accommodation after childbirth and in room air, spending an average of 12.71 days in the hospital. Conclusion: in this case of this research, knowing the woman’s profile and the outcomes in premature newborns is useful to encourage public policies and reduce the sequelae on mother and baby

Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership

BACKGROUND

Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it.

METHODS

Observational study, based on a cross-sectional design, carried out with data deriving from the study "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento" (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of-delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients' profile.

RESULTS

Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2.

CONCLUSION(S)

Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

INDICADORES MATERNOS DOS PARTOS ASSISTIDOS EM UM CENTRO DE PARTO NORMAL INTRA-HOSPITALAR

Objetivo: caracterizar os indicadores maternos dos partos assistidos por residentes de Enfermagem Obstétrica em um Centro de Parto Normal Intra-hospitalar. Métodos: estudo descritivo, documental e retrospectivo realizado utilizando o Livro de Registro de Partos assistidos pelos residentes, com total de 421 partos. Os dados foram processados no Programa Statical Package for the Social Sciences. Foram calculadas as frequências relativa/absoluta, teste qui-quadrado de Pearson e IC 95%. Resultados: 54,2% das mulheres eram multíparas, 89,1% teve gestação a termo, 95,5% foi admitida em fase ativa do trabalho de parto, 71,0% sofreu algum grau de laceração perineal, em 1,4% a episiotomia foi realizada. Os métodos não farmacológicos para alívio da dor mais utilizados foram respiração consciente, banho de aspersão, deambulação, massoterapia e bola suíça, respectivamente. Conclusão: a atuação dos residentes de enfermagem obstétrica possibilita a implementação de ações no ambiente de trabalho com foco na satisfação da mulher, na segurança do paciente e na qualidade da assistência.

The effect of educational technology use to guide parturient women's companions: a randomized controlled study

OBJECTIVE

To evaluate the companion's role during the labor and delivery processes, comparing the influence of the use of an educational technology.

METHOD

A single-blind randomized controlled study, in which 73 participants were divided into two groups, 35 in the intervention group and 38 in the comparison group. To analyze the groups the chi-square and the Fisher's exact tests were used in categorical variables and the Student's t-test or the Mann-Whitney test in continuous variables.

RESULTS

When comparing the experience and the support provided, it was found that there was no difference between the groups in relation to the level of support (p=0.48) and satisfaction with the experience of monitoring the delivery process (p=0.19). However, there was a difference regarding insecurity in monitoring (p=0.00) and concern regarding the parturient health status (p=0.00).

CONCLUSION

The companions who received the intervention with educational technology were more likely to use physical, emotional and intermediation support actions. Registry of Brazilian Clinical Trials UTN: U1111-1231-8695.

Factors related to perineal outcome after vaginal delivery in primiparas: a cross-sectional study

OBJECTIVE

Identify the associations between perineal outcome in primiparas and interventions during labor and delivery, newborn weight and APGAR score.

METHOD

Document-based, correlational, retrospective, quantitative study conducted in a tertiary maternity hospital in the state of Ceará, between July 2017 and January 2018. The independent variables were labor induction, amniotomy, non-pharmaceutical methods for relieving pain, forceps, episiotomy, Kristeller maneuver, position in the expulsion stage, shoulder dystocia, and newborn weight and APGAR score, and the dependent variable was perineal outcome. Pearson's chi-square test and Fisher's exact test were used.

RESULTS

A total of 226 normal-risk primiparas who had a vaginal delivery. An association was found between horizontal position in the expulsion stage and episiotomy, and between not performing an episiotomy and perineal tearing. The other variables (labor, delivery and neonatal) did not have any effect on perineal tearing.

CONCLUSION

Interventions, with the exception of episiotomies, did not have an influence on the occurrence of perineal trauma, but they do need to be carefully assessed. Deliveries in a horizontal position were associated with a higher likelihood of performing an episiotomy.

Educational hypermedia in nursing assistance at birth: building and validation of content and appearance

OBJECTIVE

to build an educational hypermedia about nursing care at usual risk birth and to perform validation of content and appearance.

METHOD

methodological research carried out following the following stages: content and planning of modules; media production and organization of tutorial units; organization of student space, tutor and communication between them; availability of hypermedia; assessment by experts in nursing and informatics; and implementation of proposed suggestions.

RESULTS

educational hypermedia showed to be a validated material, since it presented an optimum index of global content of 0.97 and statistical significance in the binomial test for the content and appearance.

CONCLUSION

it is believed that the use of this material with undergraduate students in nursing will contribute to the quality of obstetric care, considering that it is an illustrated technology capable of favoring teaching-learning about normal humanized childbirth.

Comparison between near miss criteria in a maternal intensive care unit

OBJECTIVE

The aim of this study was to compare the incidence of different criteria of maternal near miss in women admitted to an obstetric intensive care unit and their sensitivity and specificity in identifying cases that have evolved to morbidity.

METHOD

A cross-sectional analytical epidemiological study was conducted with women admitted to the intensive care unit of the Maternity School Assis Chateaubriand in Ceará, Brazil. The Chi-square test and odds ratio were used.

RESULTS

560 records were analyzed. The incidence of maternal near miss ranged from 20.7 in the Waterstone criteria to 12.4 in the Geller criteria. The maternal near-miss mortality ratio varied from 4.6:1 to 7.1:1, showing better index in the Waterstone criteria, which encompasses a greater spectrum of severity. The Geller and Mantel criteria, however, presented high sensitivity and low specificity. Except for the Waterstone criteria, there was an association between the three other criteria and maternal death.

CONCLUSION

The high specificity of Geller and Mantel criteria in identifying maternal near miss considering the World Health Organization criteria as a gold standard and a lack of association between the criteria of Waterstone with maternal death.

Avaliação do processo na assistência pré-natal de gestantes com risco habitual

Resumo Objetivo Avaliar a qualidade do cuidado quanto ao processo no pré-natal de gestantes com risco habitual. Métodos Pesquisa avaliativa, realizada no período de maio de 2015 a janeiro de 2016, na Casa de Parto Natural (CPN) Lígia Barros Costa em Fortaleza, Ceará. A amostra totalizou 560 prontuários de gestantes que realizaram pré-natal na CPN. O instrumento de coleta dos dados contemplou aspectos sociodemográficos, clínicos e obstétricos, e indicadores de processo da assistência pré-natal. Os critérios adotados para avaliar o processo foram os indicadores de qualidade do pré-natal. Os dados foram armazenados e processados no programa estatístico Statistical Package for the Social Sciences versão 20.0. A análise utilizou a estatística descritiva. Resultados Quanto aos indicadores de qualidade do pré-natal, observou-se que 42,3% (n=237) atenderam ao número adequado de consultas, realizando sete ou mais consultas. Apenas 26,3% (n=147) iniciaram precocemente o pré-natal. Referente aos indicadores de qualidade dos procedimentos clínicos e obstétricos verificou-se que 55% (n=309) estava adequado. Quando analisados os indicadores de qualidade referentes aos exames laboratoriais, apenas 25,4% (n=142) estavam adequados. Conclusão Conclui-se que a qualidade do pré-natal é adequada na minoria da população estudada, devendo existir maior atenção de gestores e profissionais para o planejamento de ações em prol da melhoria dos indicadores relacionados aos números de consultas, início precoce do pré-natal, procedimentos clínicos e obstétricos e realização dos exames laboratoriais.

Efficacy of an educational manual for childbirth companions: pilot study of a randomized clinical trial

Objective:

to evaluate the effectiveness of an educational manual in the instrumentalization of companions to provide support to the parturients and check its influence on the satisfaction of companions and women during vaginal delivery.

Method:

pilot study of a randomized controlled clinical trial with 65 companions and puerperal women (intervention = 21 and control = 44). The previous knowledge of the companions was evaluated at baseline. The Evaluation Form for Companions in the Delivery Room was used to measure the actions provided and the satisfaction with the experience, and the Questionnaire for Evaluation of the Experience and Satisfaction of Puerperal Women with Labor and Delivery was used to evaluate the satisfaction of women with childbirth. The Student’s t-test or Wilcoxon, chi-square or Fisher’s exact test, risk ratios and 95% confidence intervals were used.

Results:

the companions in the intervention group performed a greater number of support actions (7.2 vs 4.6, p: 0.001) and had higher satisfaction scores (72.4 vs 64.2; p = 0.00). Puerperal women in the intervention group had higher satisfaction with childbirth (119.6 vs 107.9; p: 0.000).

Conclusion:

the manual was effective for the instrumentalization of companions, contributed to support actions to the parturients and had repercussions on the satisfaction of companions and women with the birthing process. RBR-776d9s

Development and validating an educational booklet for childbirth companions

Objective The article describes the steps in producing and validating an educational booklet for childbirth companions. Method Methodological study conducted in 2011 consisting of the following steps: situational assessment; establishing brochure content; content selection and referencing; drafting the text; design of illustrations; layout; consultation of specialists; consultation of target audience; amendments; proofreading; evaluation using the Flesch Reading Ease Formula. The topics portrayed the sequence of events involving support from gestation to the postpartum period. Results The concordance rate among companions was greater than or equal to 81.8% for the topics organisation, writing style, presentation and motives. The overall Content Validity Index of the booklet was 0.94. The booklet was classified as easy reading or very easy reading according to the results of the Flesch Reading Ease Formula. Conclusion The presentation and content of the manual were validated for use with the target audience by the specialists and representatives of the target audience.

Avaliação epidemiológica da prevenção da transmissão vertical do HIV

Objetivo: Avaliar as ações direcionadas à prevenção da transmissão vertical do HIV. Métodos: Estudo epidemiológico e documental constituído por 1364 gestantes soropositivas notificadas no Sistema de Informação de Agravos de Notificação no período de dez anos. Os dados foram expressos em frequências e uma análise de regressão linear foi aplicada. Utilizou-se para a análise estatística software R versão 2.12.1. Resultados: Houve ascensão nos casos notificados de gestantes soropositivas no período; 41,72% usaram terapia antirretroviral no pré-natal; a cobertura pré-natal foi de 84,53%; houve 63,12% de prevalência de partos cesáreos; 67,01% das parturientes usaram antirretrovirais durante o parto e 71,48% das crianças iniciaram a terapia nas primeiras 24 horas de vida. Conclusão: As ações direcionadas à prevenção da transmissão vertical do HIV são parcialmente efetivas porque menos da metade das gestantes infectadas usaram terapia antirretroviral no período pré-natal.

[Vaginal discharge in pregnant women: comparison between syndromic approach and examination of clinical nursing practice]

This is a study for assessment of a quantitative approach in pregnant women (N=104), in which findings of vaginal infection were compared. The findings were obtained by two means, flowchart of vaginal discharge, and typical examinations in the clinical nursing practice. Data were collected from January to July 2011 through interviews and gynecological examinations. The flowchart showed no efficacy to identify candidiasis and trichomoniasis. Furthermore, it showed low sensitivity (0.0%; 50%) and positive predictive value (0.0%; 3.6%) for both infections, and low specificity for trichomoniasis (46%). The flowchart was shown to be satisfactory for bacterial vaginosis, with high sensitivity (100%), negative predictive value (100%), and accuracy (74%). We conclude that use of the flowchart should be reassessed, as it was not able to identify important infections in pregnant women. A continuous effort must be directed for development of effective tests in order to prevent the spread of infection and reduce the number of unnecessary treatments.

Grau de conhecimento, atitudes e práticas de puérperas sobre a infecção por HIV e sua prevenção

Objetivo: Avaliar o grau de conhecimento, atitudes e práticas de puérperas sobre a infecção por HIV e sua prevenção. Métodos: Estudo transversal com 278 puérperas internadas no sistema de alojamento conjunto. Foram realizadas entrevistas com a utilização de um questionário para avaliar o conhecimento, a atitude e a prática sobre a infecção pelo HIV e sua prevenção. Resultados: A idade das puérperas variou de 13 a 43 anos, prevalecendo faixa entre 20 e 34 anos. Predominou escolaridade entre 8 e 11 anos de estudos e união estável. Apenas 54 (19,4%) puérperas apresentaram conhecimento adequado, 6 (2,2%) atitude e 4 (1,4%) práticas adequadas. Conclusão: O conhecimento foi inadequado devido ao baixo percentual de puérperas que souberam citar pelo menos três formas de transmissão e três formas de prevenção do vírus; a atitude inadequada foi marcada pelo elevado percentual de puérperas que percebem como "improvável" infectar-se com o HIV e "pouco provável" o mesmo ocorrer com seu parceiro. A prática inadequada foi influenciada pelo baixo percentual de realização do teste anti-HIV nos períodos preconizados e pelo não uso do preservativo durante a gravidez.

[Congenital syphilis in Ceará: epidemiological analysis of one decade]

This study evaluates the incidence of congenital syphilis in the Brazilian state of Ceará from 2000 to 2009, describes the epidemiologic profile of pregnant women whose newborns had congenital syphilis and verifies the receipt of prenatal care and treatment of their partners. It is a retrospective study that was conducted in July 2010 using a Center for Information and Analysis in Health database that contains information on National Notifiable Diseases. There were 2,930 reported cases of congenital syphilis, demonstrating an annual ascending historical series. The majority of the pregnant women were 20 to 34 years of age (n=1,836, 62.7%), illiterate or with little education (n=1623, 55.4%) and had received prenatal care (n=2077, 70.9%). The inadequate treatment of women and the lack of treatment for their partners is a reality in Ceará. The incidence of congenital syphilis is a quality indicator of prenatal care. Therefore, its increase in the last ten years highlights the necessity of syphilis control.

[Pregnancy in adolescence description and analysis of care provided]

This work is aimed at describing and analyzing prenatal care to teenage women through the Brazilian Prenatal and Birth Humanization Program (BPBHP). It's a descriptive quantitative study conducted between March and July 2009 based on a form and interview with 200 teenage women during the postpartum period in a maternity ward of Sistema Unico de Satúde (Brazilian Unified Health System), which is considered a reference in obstetric care. The young women received prenatal care through the public service (96.4%) which began during the first trimester (47.4%), they didn't have the minimum medical appointments required (52.6%), took iron supplements (96.9%), received tetanus immunization (80.5%) and didn't have enough orientation (46.0%). The laboratory tests were performed during their first medical appointment (80.0%), but only a third were repeated in the third trimester. Therefore, the BPBHP doesn't meet all the standards set by the Ministéio da Saúde (Ministry of Health), and there are improvements to be made in the early service phase, ongoing care, demand for second exam samples and availability of orientation.

O perfil das puérperas adolescentes atendidas em uma maternidade de referência de Fortaleza-Ceará

Objetivou-se caracterizar o perfil das puérperas adolescentes de uma maternidade de Fortaleza-CE. Estudo descritivo, transversal e quantitativo, realizado no Alojamento Conjunto da Maternidade Escola Assis Chateaubriand, no período de março a julho de 2009, com 200 adolescentes. Os dados foram obtidos por meio de entrevistas. A maioria apresentava idade entre 15 e 19 anos (91,0%), residia na capital (78,0%), vivia com o pai de seu filho (64,5%), tinha baixa escolaridade (55,5%), considerava-se parda (61,5%) e dona-de-casa (53%). Quanto aos métodos anticonceptivos, 73,5% usaram algum método antes de engravidar, 65,5% desejaram a gravidez e 32,5% planejaram a gravidez. Durante a gravidez, 18,5% tiveram internação hospitalar e 82,5% não utilizavam drogas. Torna-se relevante a função do enfermeiro como educador em saúde para orientá-las e torná-las autônomas na promoção de sua saúde sexual.

[The knowledge of women with diabetes mellitus regarding preconception care and maternal-fetal risks]

The objective of this study was to describe the reproductive profile of women with diabetes mellitus (DM) and to identify their knowledge regarding maternal and fetal risks and preconception care. This exploratory study was performed at the Integrated Center for Hypertension and Diabetes, from March to July 2009, on a sample consisting of 106 women. The variables were: number of pregnancies, births and abortions, and planning the pregnancy. The data were collected through interviews that followed a preconceived form. The reproductive profile of women with DM proved to be permeated with risks and showed negative repercussions to maternal and fetal health. Of the 106 (100%) women studied, 44 (41.5%) demonstrated adequate knowledge regarding preconception care, while 58 (54.7%) had limited knowledge regarding maternal and fetal risks. It is necessary to provide information to women with diabetes to promote knowledge of maternal and fetal risks and preconceptional care.

Presence of high-grade intraepithelial lesions among women deprived of their liberty: a documental study

The aim of this study was to analyze the results of the Pap smears of women deprived of their liberty. It is a retrospective, documental study, with a quantitative approach, performed in a female prison of Ceará, Brazil, with a sample of 672 patient records. Regarding the microbiological findings, it was verified that the main cervical-vaginal colonization was by bacilli suggestive of Gardnerella/Mobiluncus (21.8%), followed by Trichomonas vaginalis (12%), and Candida sp (5.8%). The frequencies of samples with atypical cells presented rates of 4.1% for Atypical Cells of Undetermined Significance; 3.2% for Low-grade Intraepithelial Lesions; and 2.5% for High-grade Intraepithelial Lesions. The importance of screening for cervical cancer in female prisons was highlighted, as well as the inclusion of the nurse in this environment, ensuring individualized, quality care for women deprived of their liberty.

Óbitos maternos em uma maternidade pública de Fortaleza: um estudo epidemiológico

O objetivo do estudo foi analisar os óbitos maternos ocorridos em uma Maternidade Pública de Fortaleza-CE e identificar a existência de associações entre o momento do óbito e as causas do óbito. Foram revisados prontuários, declarações de óbito e fichas de notificação referentes aos 96 óbitos maternos ocorridos entre 2000 e 2008. O tipo de parto mais prevalente foi o cesáreo (45;46,8%) e as causas de óbitos mais evidenciadas foram: síndrome hipertensiva (27;28,1%); infecção (17;17,7%); e hemorragia (16;16,7%). Houve associação estatística significante entre: cesariana e as causas de óbito síndrome hipertensiva e infecção (x²:14,40, p:0,00; x²:4,02, p:0,04); mortes ocorridas no puerpério e síndrome hipertensiva (x²:6,13, p:0,01) e infecção (x²:7,65, p:0,00). A caracterização desses óbitos auxilia no reconhecimento dos grupos de risco e na elaboração de medidas preventivas.

Exame físico no pré-natal: construção e validação de hipermídia educativa para a Enfermagem

OBJETIVO: Descrever o processo de desenvolvimento e validação de uma hipermídia educacional para graduandos e profissionais de enfermagem a respeito da técnica de realização do exame físico no pré-natal. MÉTODOS: Estudo de desenvolvimento, realizado entre junho e outubro de 2010, seguindo as etapas: levantamento do conteúdo, produção das mídias, organização do espaço aluno-tutor, elaboração, disponibilização e validação da hipermídia. RESULTADOS: Foram desenvolvidos hipertextos, hiperlinks, recursos audiovisuais, espaços de comunicação, avaliações e material de apoio. Os sete especialistas em enfermagem consideraram totalmente adequada a coerência da hipermídia para a prática de enfermagem e para a facilitação do processo ensino-aprendizagem. Dos três especialistas em Informática, dois consideraram totalmente adequada a funcionalidade da hipermídia. CONCLUSÃO: Construiu-se construiu uma hipermídia, utilizando diversos recursos midiáticos que a tornam apta a otimizar o processo ensino e aprendizagem e que foi validada por especialistas.

Análise da capacidade diagnóstica dos exames preventivos do câncer de colo uterino

OBJETIVO: Avaliar a capacidade diagnóstica dos exames citológicos, colposcópico e histológico na detecção de lesões pré-malignas. MÉTODOS: Estudo documental, retrospectivo, com abordagem quantitativa, realizado no Instituto de Prevenção do Câncer (IPC), em Fortaleza-CE. A população foi composta por prontuários de 112 mulheres que possuíam o resultado dos três exames. Adotou-se o teste de qui-quadrado e considerou-se estatisticamente significativo quando p < 0,05. Foram aplicados a sensibilidade e especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) para a citologia e colposcopia. RESULTADOS: A partir da comparação entre os exames diagnósticos observou-se que a citologia obteve uma sensibilidade de 89,8%, uma especificidade de 35,7%, um VPP de 90,7% e um VPN de 33,3%. A colposcopia alcançou uma sensibilidade de 84,7%, uma especificidade de 50%, um VPP de 92,2% e um VPN de 31,8%. CONCLUSÃO: Observou-se que esses exames apresentaram valores de sensibilidade e especificidade que podem alternar-se, indicando-se a associação de ambos para melhorar a acurácia do diagnóstico das lesões pré-malignas.

Atenção em anticoncepção oferecida por equipe de PSF em São Gonçalo do Amarante – CE

doi: 10.5216/ree.v12i4.5870 Conhecer o perfil dos usuários de serviços de Planejamento Familiar (PF) do Programa de Saúde da Família (PSF) e a atenção em anticoncepção dispensada é de fundamental importância para a elaboração de estratégias adequadas às necessidades da população. Objetivou-se conhecer o perfil socioeconômico e gineco-obstétrico de mulheres usuárias de um serviço de PF do PSF; identificar os Métodos Anticoncepcionais (MAC) mais utilizados por essa clientela e queixas relacionadas ao uso destes; e verificar a regularidade do acompanhamento dessas usuárias. Estudo retrospectivo, documental, quantitativo, realizado em 2008, em São Gonçalo do Amarante - CE. Entre 171 prontuários do serviço de PF de duas micro-áreas do PSF Croata II, escolhidos aleatoriamente, 158 (92,4%) correspondiam a usuários do gênero feminino. Os MAC mais utilizados pelas usuárias, antes e após a atenção recebida em PF, foram o Anticoncepcional Combinado Oral (ACO) e o condom. As queixas mais frequentes entre as usuárias de MAC estiveram associadas ao uso de dispositivo intra-uterino e contraceptivo injetável, sendo o deslocamento e dismenorréia, respectivamente. Quanto à regularidade de acompanhamento das usuárias no serviço de PF, verificaram-se ausências de retorno e retornos repetitivos que sugerem a reorganização do protocolo de acompanhamento das mesmas pelo programa. Descritores: Planejamento familiar; Anticoncepção; Programa Saúde da Família.

A cultura no cuidado familiar à criança vítima de queimaduras

O cuidado de enfermagem à criança queimada está diretamente relacionado à aceitação da família, tendo os pais como parceiros e informantes das condições de saúde da vítima. Objetivou-se compreender como as crenças, valores e estilo de vida das famílias influenciam no cuidado de crianças vítimas de queimaduras internadas em um Centro de Tratamento de Queimados. Pesquisa etnográfica realizada em um Hospital de Urgência e Emergência, em Fortaleza, Ceará, no período de abril a agosto de 2008,na qual a coleta e a análise dos dados se embasaram na Etnoenfermagem. Na ordenação e análise dos dados adotaram-se as seguintes etapas: coleta de descritos e documentos; agrupamento dos dados; análise contextual de temas principais; descobertas de pesquisa; formulações teóricas e recomendações. Das análises surgiram três categorias: A criança é muito danada;A gravidade da situação; Ter mais cuidado.Conforme o estudo durante a internação, as mães, apesar de possuírem seus conhecimentos culturais, aprenderam muito, tinham muitas dúvidas e refletiram sobre o próprio cuidado com seus filhos.É,pois, imprescindível que o enfermeiro utilize estratégias que inerentes à cultura familiar com vistas a cuidar de forma individualizada, criando vínculos com essas crianças e família. Descritores: Enfermagem pediátrica; Cuidados de enfermagem; Antropologia cultural.