MENTAL HEALTH OF MOTHERS AFTER NATURAL CHILDBIRTH AND CESAREAN SECTION: A COMPARATIVE STUDY IN KOHAT, KHYBER PAKHTUNKHWA, PAKISTAN

ABSTRACT Objective: to compare the quality of life of women after natural childbirth and cesarean section from a mental health perspective. Method: this is a causal-comparative study that included 104 women, 52 of whom underwent natural childbirth: and 52 cesarean sections. It was conducted in the gynecology ward of Liaqat Memorial Hospital in Kohat Khyber Pakhtunkhwa, Pakistan using the Quality-of-Life Questionnaire. Pakistani Nurses made direct translation of it in to Urdu language, interview by interview (read in English and told in Urdu). The results related to Emotional Health Problems, Energy, Emotions and Social Activities were analyzed. Results: women after cesarean section reported more problems regarding emotional health variables than women after natural childbirth. The mean quality of life score among the natural childbirth group was 89.94 and 66.02 among the cesarean section group (p<0.001). Conclusion: women who undergo natural childbirth have better quality of life than women who undergo cesarean section (average versus poor quality of life). Mental health is also affected, especially for those who undergo cesarean section. Thus, natural childbirth demonstrates benefits in the puerperium in terms of emotional indicators.

Care technologies to prevent and control hemorrhage in the third stage of labor: a systematic review

OBJECTIVE

to identify evidence concerning the contribution of health technologies used to prevent and control hemorrhaging in the third stage of labor.

METHOD

systematic review with database searches. First, two researchers independently selected the papers and, at a second point in time, held a reconciliation meeting. The Kappa coefficient was used to assess agreement, while the Grading of Recommendations, Assessment, Development and Evaluation was adopted to assess risk of bias and classify level of evidence.

RESULTS

in this review, 42 papers were included, 34 of which addressed product technologies, most referred to pharmacological products, while two papers addressed the use of blood transparent plastic bags collector and the contribution of birth spacing and prenatal care. The eight papers addressing process technologies included the active management of the third stage of labor, controlled cord traction, uterine massage, and educational interventions.

CONCLUSION

product and process technologies presented high and moderate evidence confirmed in 61.90% of the papers. The levels of evidence confirm the contribution of technologies to prevent and control hemorrhaging. Clinical nurses should provide scientific-based care and develop protocols addressing nursing care actions.

Therapeutic communities in Santa Catarina, Brazil

Purpose

The purpose of this paper is to present a case study of a programme aimed at raising standards of care and levels of professionalism in private, drug-free therapeutic communities (TCs) in Santa Catarina, Brazil.

Design/methodology/approach

The paper describes the Reviver intervention in detail and draws on subjective insights collected during its implementation.

Findings

Over 100 TCs applied to the Reviver project, of which 83 qualified to participate. The large majority of TCs were found to combine community-as-method, religious worship and abstinence in their treatment model.

Research limitations/implications

The paper highlights the significant role religious organisations have in the treating substance dependency in Brazil and raises ethical and practical questions regarding the incorporation of religious TCs into mainstream public mental health provision.

Practical implications

The paper outlines the qualification process, control systems and monitoring procedures employed by the Reviver project.

Originality/value

The paper attends to the gap in English language publications regarding TCs in Brazil and raises important questions regarding the role of religion, faith and spirituality in the treatment of substance dependency.

ADAPTAÇÃO TRANSCULTURAL DE INSTRUMENTOS DE PESQUISA CONDUZIDA PELA ENFERMAGEM DO BRASIL: UMA REVISÃO INTEGRATIVA

RESUMO Objetivo: identificar e analisar as abordagens teóricas e propostas processuais utilizadas na adaptação transcultural de instrumentos de pesquisa para a língua portuguesa, pela enfermagem brasileira. Método: revisão integrativa de artigos que descreviam o processo de adaptação transcultural de instrumentos utilizados na prática clínica hospitalar, publicados entre 2005-2016. A busca foi realizada na MEDLINE®, CINAHL®, Scopus®, Web of science®, LILACS®, BDENF e SciELO®. Foram analisados 22 artigos, identificando-se as etapas do processo de adaptação, a abordagem metodológica, o instrumento e especialidade clínica. Resultados: todos os estudos utilizaram a abordagem universalista e em 20 deles Beaton foi o referencial metodológico adotado. Dentre os pontos fortes, destacam-se a adoção de referenciais metodológicos, cumprimento e detalhamento dos procedimentos adotados no processo, validação de conteúdo e avaliação psicométrica. Entretanto, a fragilidade predominante foi a ausência de informações importantes do processo de adaptação. Conclusão: evidencia-se uma supervalorização da avaliação psicométrica, em detrimento do cumprimento rigoroso do processo adaptação. Os achados possibilitam a elaboração de recomendações para estudos de adaptação transcultural, que podem subsidiar futuras pesquisas deste método.

Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

Objective

analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil.

Methods

a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests.

Results

differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001), have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001) and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001) than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years.

Conclusion

this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

Detection of Zika virus in Brazilian patients during the first five days of infection - urine versus plasma

Advantages of testing for Zika virus (ZIKV) in urine have been reported, such as the persistence of ZIKV in this type of specimen for up to 20 days after ZIKV disease onset. We investigate 61 patients in the first 5 days post-symptom onset and find more patients testing positive for ZIKV in plasma samples (n=46), than in corresponding urine samples (n=37). For patients respectively testing positive in both plasma and urine (n=28), respective viral loads appeared similar.

THE PROFESSIONAL IDENTITY OF NURSING IN THE PAPERS PUBLISHED BY REBEN

ABSTRACT Objective: to analyze the content of scientific papers published in the Brazilian Journal of Nursing (REBEn) concerning the professional identity of nursing. Method: This qualitative study used content analysis. The study’s corpus was composed of scientific papers published in REBEn from 1983 to 2012; 55 papers were selected. Results: The analysis considered the theoretical propositions of Eliot Freidson concerning the Sociology of Professions. Conclusion: The conclusion is that the papers published in REBEn reveal theoretical inadequacy in the analytical matrix of the nursing profession. Therefore, theoretical studies addressing the nursing profession are needed to support propositions consistent with the complexity of conflicts and how to overcome them.

Women's Views on Handling and Managing Their Breast Cancer in Pakistan: A Qualitative Study

In this study, we examine and analyze the experiences of women and their perceptions on handling and managing their breast cancer. Seven women from Peshawar, Pakistan who had breast cancer and have been cured, were interviewed. Qualitative content analysis of their life stories was performed using a computerized software Atlas.ti. In the coding process, 128 codes were initially developed. These codes were then grouped into 12 categories, which were then further refined into 8 theoretically grounded categories: awareness and education about breast cancer, cultural barriers, early detection, quality of care and treatment, support, side effects, courage and learned to face challenges. The early views of participant’s feelings about breast cancer are mostly similar to the general population in Pakistan. Before starting treatment, all participant were unaware of the treatment process and had fear in their mind. They were hesitant in starting their treatment and were worried. However, when they were cured, their attitudes toward breast cancer and even to their whole lives were changed. Comprehensive awareness programs in a culturally acceptable language and facilities for routine breast examinations should be easily accessible to all women in Pakistan in order to promote early detection. In order to eradicate cultural barriers, female staff who are trained to perform routine breast examinations, should be available in all facilities and treatment centers.

Investigation Into an Outbreak of Dengue-like Illness in Pernambuco, Brazil, Revealed a Cocirculation of Zika, Chikungunya, and Dengue Virus Type 1

In April 2015, an outbreak of dengue-like illness occurred in Tuparetama, a small city in the northeast region of Brazil; this outbreak was characterized by its fast expansion. An investigation was initiated to identify the viral etiologies and advise the health authorities on implementing control measures to contain the outbreak. This is the first report of this outbreak in the northeast, even though a few cases were documented earlier in a neighboring city.Plasma samples were obtained from 77 suspected dengue patients attending the main hospital in the city. Laboratory assays, such as real-time reverse transcription polymerase chain reaction, virus cDNA sequencing, and enzyme-linked immunosorbent assay, were employed to identify the infecting virus and molecular phylogenetic analysis was performed to define the circulating viral genotypes.RNA of Zika virus (ZIKV) and Dengue virus (DENV) or IgM antibodies (Abs) to DENV or chikungunya (CHIKV) were detected in 40 of the 77 plasma samples (51.9%). DENV was found in 9 patients (11.7%), ZIKV was found in 31 patients (40.2%), CHIKV in 1 patient (1.3%), and coinfection of DENV and ZIKV was detected in 2 patients (2.6%). The phylogenetic analysis of 2 available partial DENV and 14 ZIKV sequences revealed the identities of genotype 1 and the Asiatic lineage, respectively.Consistent with recent reports from the same region, our results showed that the ongoing outbreak is caused by ZIKV, DENV, and CHIKV. This emphasizes the need for a routine and differential diagnosis of arboviruses in patients with dengue-like illness. Coordinated efforts are necessary to contain the outbreak. Continued surveillance will be important to assess the effectiveness of current and future prevention strategies.

POSTNATAL CARE IN BRAZIL: OPPORTUNITIES AND CHALLENGES

ABSTRACT Aim: in this paper the authors described the experience in proposition and realization of a workshop in a partnership between UK and Brazilian researchers. The aim was plan out a strategy for the successful implementation of interventions to improve the health and wellbeing of women's postnatal care in Brazil. Method: this is an experience report about the implementation of that workshop. It was held in the Universidade Federal de Santa Catarina, from 7 to 10 March 2016, under the auspices of the British Council Researcher Links Scheme, funded through the Newton Fund and Brazilian Council of the State Foundations of Research, Sciences and Innovation represented in Santa Catarina by Foundation for Research and Innovation of Santa Catarina. Results: during the workshop were presented health and social care experiences of women in Brazil from pregnancy through to the months after birth, integrated review of social technology in health, the importance of specific public health initiatives and good health surveillance in a country as large and multi-cultured as Brazil. It was also carried out a meeting between health professionals and women and their partners who had received postnatal care. Each day we worked in small groups to identify the research areas that we were interested in moving forward with as a Brazil-UK research network. Conclusions: a number of perceived opportunities and challenges were identified during the workshop from researchers, practitioners, parents and policy makers. The success of social technology interventions depends on their appropriate introduction within Brazil's social and healthcare context.

Mortality due to cervical cancer, 1996-2011, Santa Catarina, Brazil

Population-based quantitative study. This study's objectives were to examine the influence of regions, age, and time on cervical cancer mortality. We analyzed cervical cancer mortality rates in the State of Santa Catarina, Brazil between 1996 and 2011. Data were obtained from the Mortality Information System from the Brazilian Ministry of Health in 2013. Data were analyzed based on descriptive epidemiology. Cervical cancer mortality rates ranged from 3.6 to 5.0/100,000 women. Rates were higher among older women, with the highest rates after the age of 70. Women's awareness regarding the importance of the Pap smear test in their health checkups may differ across ages and regions of residence. The frequency of Pap smears should change due to the trend of mortality rates observed over time.

Maternal mortality due to hemorrhage in Brazil

OBJECTIVE

to analyze the rates of maternal mortality due to hemorrhage identified in Brazil from 1997 to 2009.

METHODS

the time series and population data from the Brazilian Health Ministry, Mortality Information System and Live Birth Information System were examined. From the Mortality Information System, we initially selected all reported deaths of women between 10 and 49 years old, which occurred from January 1, 1997 to December 31, 2009 in Brazil, recorded as a "maternal death".

RESULTS

during the research period, 22,281 maternal deaths were identified, among which 3,179 were due to hemorrhage, accounting for 14.26% of the total deaths. The highest rates of maternal mortality were found in the North and Northeast areas of Brazil.

CONCLUSIONS

the Brazilian scenario shows regional inequalities regarding maternal mortality. It presents hemorrhaging as a symptom and not as a cause of death.

[Maternal mortality from hemorrhage in the State of Santa Catarina, Brazil]

Hemorrhage represents a set of causes that focuses on women during the pregnancy and puerperal period, and that, with improper attention, results in death. The authors aimed to analyze maternal deaths related to hemorrhage that occurred in the state of Santa Catarina, Brazil. The data were obtained from the Mortality Information System and Live Births Information System from the Brazilian Ministry of Health. This was a descriptive study, in which 491 maternal deaths that occurred in the period 1997-2010 were analyzed. Of these, 61 were related to hemorrhage, corresponding to 12.42%; postpartum hemorrhage was the most prevalent cause, with 26 deaths, followed by placental abruption with 15, representing 67.21% of the cases. The maternal mortality from hemorrhage is a public health problem in the state of Santa Catarina, due to its high prevalence and the fact that its underlying causes are preventable.

Câncer de colo do útero: mortalidade em santa catarina - Brasil, 2000 a 2009

O câncer de colo do útero no Brasil é a terceira neoplasia mais comum em mulheres e apresenta alta mortalidade. O objetivo foi o de avaliar a mortalidade por câncer de colo do útero, ocorrida no Estado de Santa Catarina, no período de 2000 a 2009. Estudo descritivo de base populacional, com a inclusão de todos os óbitos de mulheres, por câncer de colo do útero. Nos dados coletados do Sistema de Informação de Mortalidade, do Ministério da Saúde brasileiro, foram identificadas 1253 mortes de mulheres associadas a esta neoplasia. A taxa de mortalidade calculada variou no período entre 3,6 a 4,9 mortes por 100.000 mulheres, sendo mais elevada em mulheres com sessenta e mais anos. A enfermagem contribui para a construção da cultura de prevenção desta neoplasia, para realização dos testes diagnósticos e para a captação e o seguimento das mulheres de risco pela rede básica de saúde.

[Girls from Santa Catarina: losing your life to become a mother]

The Maternal Mortality Ratio (MMR) is an indicator that analyses the life conditions and care given to pregnant women, and indicates whether the constitutional rights related to life and health are being complied with. This study shows losses of lives among adolescent women associated with pregnancy, childbirth and the puerperal period, in the state of Santa Catarina between 1994 and 2005. It is an exploratory study of a quantitative nature. There were 72 maternal deaths in adolescents, 67% had a direct obstetric cause, 23% had an indirect obstetric cause and about 9% were classified as accidental or incidental. The Maternal Mortality Ratio in adolescents was high and most could have been prevented and its causes controlled. The identified situation shows an absence of quality health care. To reduce these deaths it is central that nursing action be combined with other professionals and other organized sectors of society.

Violence against Amazon women

This quantitative and exploratory study analyzed violence against Amazon women presented in print media according to type and severity, and whether aggressors fell under the Maria da Penha law. A total of 181 issues of a regional newspaper were consulted. Based on content analysis, 164 items addressing violence against women were selected and 46 were included in the corpus of analysis. Results were gathered in three thematic groups: women killed with cruelty, sexual violence against women regardless of age, and violence against women and the limitations of the Maria da Penha law. Violence against these women varied in terms of form and severity, including up to homicide. Women are submitted to sexual violence from childhood through adulthood. The enforcement of this law shows the community it has a means to cope with this social phenomenon.

Mortalidade por aborto no Estado de Santa Catarina - 1996 a 2005

A mortalidade materna associada ao aborto revela as condições sociais da mulher. Este estudo, exploratório-descritivo, tem o objetivo de identificar o perfil das mulheres que tiveram morte associada ao aborto no Estado de Santa Catarina, no período de 1996 a 2005. As fontes para a coleta dos dados foram: o Sistema de Informações sobre Mortalidade e o Sistema de Informações sobre os Nascidos Vivos, do Ministério da Saúde do Brasil. Foram encontradas 31 mortes maternas associadas ao aborto; destas, 51,61% ocorreram em mulheres casadas; 38,71% das mulheres tinham de 1 a 8 anos de escolaridade, e para 48,39% o grau de instrução foi registrado como ignorado. Os dois valores mais elevados da razão de mortalidade materna foram encontrados na Região Oeste, 5,148, e na Região Norte, 4,761.

Políticas públicas na formação em saúde: contribuição da enfermagem para superação das desigualdades regionais brasileiras

O presente artigo tem por objetivo refletir acerca do compromisso social e ético da Enfermagem para a superação das desigualdades regionais brasileiras, argumentando a favor da importância e necessidade de sua contribuição à políticas públicas. No contexto da formação pós-graduada são apontados os desafios frente às desigualdades de acesso à formação strictu sensu - mestrado e doutorado na região amazônica. O acesso aos programas de pós-graduação está posto em uma política pública especifica para a região norte - Programa Acelera Amazônia e Doutorado Interinstitucional/Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Tal formação poderá contribuir com o fortalecimento de liderança local e acelerar o avanço da produção do conhecimento e do desenvolvimento tecnológico, na área da enfermagem no contexto da região amazônica. Nesse processo, é preciso exercitar de modo ético a condição de agentes de uma política pública, pois a amazônia requer um exercício diário de aprendizagem para inserí-la no contexto da ciência, da política e da cidadania nacional.

O Cuidado em Enfermagem: uma aproximação teórica

Trata o presente trabalho de uma reflexão sobre o cuidado de enfermagem elegendo a dimensão ético-política e alguns aspectos histórico-filosóficos que o caracterizam. O ato de cuidar desvela o existencial, de onde derivam sentimentos, atitudes e ações, como vontades, desejos, inclinações e impulsos, ou seja, o homem perante o mundo, os outros, e a si mesmo. Compreender o valor do cuidado de enfermagem requer uma concepção ética que contemple a vida como um bem valioso em si, começando pela valorização da própria vida para respeitar a do outro, em sua complexidade, suas escolhas, inclusive a escolha da enfermagem como uma profissão.

Subsídios para uma ética da responsabilidade em Enfermagem

Trata o presente de uma reflexão teórica sobre a ética na Enfermagem e na saúde, buscando contribuir com subsídios para a construção de uma nova ética na profissão. Aponta as limitações da ética deontológica e os desafios para a construção da ética da responsabilidade. Discute o compromisso e a responsabilidade social dos profissionais de saúde, em especial da Enfermagem, argumentando sobre como o cuidado de enfermagem precisa e deve construir-se dentro de uma conduta ética. Também aponta as limitações do ensino de ética em saúde, identificando os compromissos necessários para superá-los, haja vista a complexidade das questões éticas com que se defrontam os profissionais de enfermagem e da saúde na atualidade.