“Tabela falante” como estratégia de integração de dados em uma pesquisa de métodos mistos

RESUMO Objetivo relatar a utilização da tabela falante como estratégia de integração e análise de dados em estudo de abordagem mista. Método trata-se de um relato de utilização de uma estratégia metodológica de integração e análise dos dados em pesquisa de método misto. São apresentados dados de um estudo longitudinal analítico, que acompanhou 151 lactentes prematuros no primeiro ano de vida. O estudo abordou aspectos das condições de saúde dessa população e integrou dados quantitativos, coletados por meio de instrumento de avaliação de condições de saúde e dados qualitativos oriundos de entrevista semiestruturada. Resultados a integração dos dados em estudos mistos é uma exigência metodológica que requer dos pesquisadores a utilização de estratégias que possibilitem e facilitem esse processo analítico. A tabela falante, por meio da integração visual dos dados quantitativos expressos em tabelas e suas convergências e divergências analíticas com os enunciados qualitativos, favorece a leitura e interpretação integrada. Conclusão e implicações para a prática considera-se a tabela falante uma ferramenta analítica de integração de dados quantitativos e qualitativos que contribui na formulação de metainferências em pesquisas com métodos mistos.

“Talking table” as a data integration strategy in mixed methods research

ABSTRACT Objective to report the use of a talking table as a data analysis and integration strategy in a mixed approach study. Method this is a report on the use of a methodological strategy for data integration and analysis in mixed methods research. Data from an analytical longitudinal study that followed 151 preterm infants in the first year of life are presented. The study addressed aspects of the health conditions of this population and integrated quantitative data, collected through an instrument to assess health conditions and qualitative data from a semi-structured interview. Results data integration in mixed studies is a methodological requirement that requires researchers to use strategies that enable and facilitate this analytical process. A talking table, through the visual integration of quantitative data expressed in tables and their analytical convergences and divergences with qualitative statements, favors integrated reading and interpretation. Conclusion and implications for practice: a talking table is considered an analytical tool for quantitative and qualitative data integration, which contribute to developing meta-inferences in mixed methods research.

Prevalence of children with special healthcare needs: An epidemiological survey in Brazil

PURPOSE

We aimed to estimate the prevalence and delineate the profile of children with special healthcare needs (CSHCN) in the three municipalities of Brazil's southern and southeastern regions from 2015 to 2017.

DESIGN AND METHODS

This cross-sectional study included 6853 children aged 0-11 years. Participants were selected through complex sampling in 32 primary healthcare units. The Brazilian version of the Children with Special Healthcare Needs Screener© and a questionnaire were used to identify sociodemographic and family characteristics, health status, and health services utilization. Simple and multiple logistic regression models were used to evaluate the association between family and child characteristics and prevalence (P < 0.05).

RESULTS

The prevalence of CSHCN was 25.3% (95% confidence interval: 21.0-30.0). Most participants required health services or were on long-term medication for a current chronic condition; approximately 53% of CSHCN had no formally recorded diagnoses. The most frequent health problems were respiratory conditions, asthma, and allergies. Approximately 60% of the CSHCN patients underwent follow-up examinations of the specialties pneumology, pediatrics, otorhinolaryngology, speech therapy, neurology, and psychology. Children of school age, of male sex, with premature birth, with a history of recurrent hospitalization, from non-nuclear families, and from underprivileged social classes were identified as risk factors for classification as CSHCN.

PRACTICE IMPLICATION

These results contribute to the unprecedented mapping of these children in healthcare networks in Brazil.

CONCLUSION

The high prevalence of CSHCN in medium and large municipalities in the southern and southeastern regions was associated with the child's previous health conditions and family structure.

Strategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review

OBJECTIVE

To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit.

METHODS

This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670).

RESULTS

Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001).

CONCLUSION

There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children.

PROSPERO REGISTER

CRD 42021274670.

Strategies for the management and prevention of withdrawal syndrome in critically ill pediatric patients: a systematic review

OBJECTIVE

To verify strategies for the prevention and treatment of abstinence syndrome in a pediatric intensive care unit.

METHODS

This is a systematic review in the PubMed database®, Lilacs, Embase, Web of Science, Cochrane, Cinahl, Cochrane Database Systematic Review and CENTRAL. A three-step search strategy was used for this review, and the protocol was approved in PROSPERO (CRD42021274670).

RESULTS

Twelve articles were included in the analysis. There was great heterogeneity among the studies included, especially regarding the therapeutic regimens used for sedation and analgesia. Midazolam doses ranged from 0.05mg/kg/hour to 0.3mg/kg/hour. Morphine also varied considerably, from 10mcg/kg/hour to 30mcg/kg/hour, between studies. Among the 12 selected studies, the most commonly used scale for the identification of withdrawal symptoms was the Sophia Observational Withdrawal Symptoms Scale. In three studies, there was a statistically significant difference in the prevention and management of the withdrawal syndrome due to the implementation of different protocols (p < 0.01 and p < 0.001).

CONCLUSION

There was great variation in the sedoanalgesia regimen used by the studies and the method of weaning and evaluation of withdrawal syndrome. More studies are needed to provide more robust evidence about the most appropriate treatment for the prevention and reduction of withdrawal signs and symptoms in critically ill children.

PROSPERO REGISTER

CRD 42021274670.

Social and territorial inequalities in the mortality of children and adolescents due to COVID-19 in Brazil

OBJECTIVE

To analyze the mortality rate of COVID-19 among children and adolescents aged 0 to 14 years.

METHODS

Ecological and exploratory study of children's mortality rate by COVID-19 in Brazil, from February to October 2020. The study used the Severe Acute Respiratory Syndrome database to collect the data and made the analysis using descriptive spatial statistics by age and race/color classification.

RESULT

The mortality rate due to COVID-19 represented 1.34 deaths per one hundred thousand in the total group evaluated. The age group with the highest frequency and mortality rate was 1 to 4 years of age. There is a higher frequency of deaths in the brown and Indigenous population.

CONCLUSION

The distribution of deaths due to COVID-19 is unequal in the national territory, and there is a wide variation in the mortality rate by age and race/color groups.

Screening complications in the postoperative period of orthopedic surgeries by video arthroscopy

To analyze the prevalence and characteristics of late postoperative complications of orthopedic surgeries by video arthroscopy. This was a descriptive cross-sectional study that evaluated, through its own instrument, local and systemic postoperative complications of patients undergoing orthopedic surgeries by video arthroscopy. The study included 270 patients, who were evaluated on days 30(without prosthesis) and 90(with prosthesis placement) of the postoperative period, by telephone service. The selection of participants occurred sequentially and population-based, within the data collection period, from February to July 2020, in a large hospital for medium and high complexity surgeries. Of the 270 procedures performed in the period, 4.4% (n = 12) presented late postoperative infection. The most frequent complications were erythema (83%), edema (75%) and secretion (67%) in the surgical wound. Most used antibiotic therapy (92%) and anti-inflammatory drugs (67%). Hospital readmission was not necessary concerning the complications. Only 50% required medical evaluation before the scheduled time. The need for practices that ensure the quality of perioperative care and improve the active search to assess surgical outcomes is reinforced.

Desigualdades sociais e territoriais na mortalidade de crianças e adolescentes por COVID-19 no Brasil

RESUMO Objetivo: Analisar a taxa de mortalidade por COVID-19 entre crianças e adolescentes de 0 a 14 anos. Métodos: Estudo ecológico e exploratório da taxa de mortalidade de crianças por COVID 19 no Brasil, no período de fevereiro a outubro de 2020. A coleta foi feita utilizando-se o Banco de Dados de Síndrome Respiratória Aguda Grave, e a análise foi realizada com recurso à estatística espacial descritiva, por classificação etária e de raça/cor. Resultados: A taxa de mortalidade por COVID-19 representou 1,34 mortes a cada 100 mil no grupo total avaliado. A faixa etária com maior frequência e taxa de mortalidade foi de 1 a 4 anos. Há maior frequência de óbitos na população parda e indígena. Conclusão: A distribuição de óbitos por COVID-19 é desigual no território nacional, e há grande variação da taxa de mortalidade por grupos etários e de raça/cor.

Perfil clínico e fatores associados ao óbito de pacientes COVID-19 nos primeiros meses da pandemia

RESUMO Objetivo analisar as características individuais, clínicas e os fatores associados à mortalidade de pacientes com COVID-19, em hospital público do estado do Paraná, Brasil. Métodos estudo seccional, retrospectivo, documental (n= 86), com pacientes adultos internados, de março a junho de 2020. Resultados a mortalidade foi de 12,8%, o grupo de maior risco foi de idosos com comorbidades, especialmente, cardiovasculares. A chance de óbito foi 58 vezes maior em idosos, comparada aos adultos, e oito vezes maior naqueles com comorbidades, comparadas aos hígidos. A maioria dos pacientes apresentou sintomatologia respiratória, febre e mialgia. Tratamento à base de antibióticos, anticoagulantes e antivirais, associado ao suporte ventilatório. As principais complicações foram hipóxia, insuficiência renal aguda e infecção secundária. Conclusão e implicações para a prática idosos com comorbidades cardiovasculares que necessitaram de cuidados intensivos apresentaram maior chance de óbito. Os resultados de um dos centros de referência na pandemia possibilitam discutir medidas epidemiológicas adotadas, com ênfase em conceitos restritivos nos primeiros meses.

CUIDADORES DOMICILIARES DE PESSOAS COM DEFICIÊNCIA INTELECTUAL NO CONTEXTO RURAL E SEUS DESAFIOS

Objetivo: analisar os desafios, características e sentimentos de cuidadores domiciliares de pessoas com deficiência intelectual no contexto rural. Método: trata-se de um estudo quanti-qualitativo, com 124 cuidadores de pessoas com deficiência intelectual que vivem no contexto rural, em oito municípios do sul do Brasil. Os dados foram coletados de setembro/2018 a junho/2019, por meio de um questionário com variáveis sociais, demográficas e cotidianas do cuidado. A análise foi do tipo analítica e descritiva, por meio de frequência e comparação de frequência. Resultados: os cuidadores domiciliares são mulheres, mães, irmãs, com idade avançada, pouca escolaridade, mas que, diante dos desafios como acúmulo de funções, sobrecarga de trabalho, baixa escolaridade, cansaço, isolamento social e profissional, desenvolvem suas atribuições com amor. Conclusão: o estudo contribuiu na identificação das características e desafios dos cuidadores de pessoas com deficiência intelectual no espaço rural, revelando questões para o avanço das práticas de saúde pública.

Factors associated with the development of skin allergies in premature newborns in the first year of life

OBJECTIVE

To identify the factors associated with the development of skin allergies in the first year of life in moderate and late preterm infants.

METHOD

This is a cross-sectional study with 151 moderate and late preterm infants, born between May 2016 and May 2017. Participants were evaluated in the 3rd, 6th, 9th and 12th months of life, in telephone interviews. Statistical analyzes were performed in the SPSS software with frequency comparison tests and logistic regression.

RESULTS

The prevalence of skin allergy, in the perception of caregivers, among late and moderate preterm infants was 16%. Factors such as being admitted to neonatal intensive care (p = 0.006) and not being breastfed (p = 0.041) showed a significant association with the development of skin allergies in the 3rd and 12th months of life, respectively.

CONCLUSION

Skin allergy, in the perception of caregivers, is more severe in newborn infants who have clinical respiratory and gastrointestinal manifestations, be it conditioning or cause-effect. Breastfeeding proved to be a protective factor in the first year of life.

Health care network (dis)articulation in late and moderate prematurity

OBJECTIVE

to analyze the Health Care Network (dis)articulation of late and moderate premature infants in the first year of life.

METHOD

a qualitative study with semi-structured interview, which addressed the care network constitution in a municipality in southern Brazil. Fifteen mothers of infants participated. Thematic content analysis and flowchart were used to describe networks and services.

RESULTS

first contact in Primary Health Care is a decisive factor for the recognition and articulation of neonates/infants in the network and enables resolution, especially in childcare demands. Secondary and hospital care services support isolated acute events or chronic conditions, without articulation between levels of care and in a uniprofessional way.

FINAL CONSIDERATIONS

attention to health conditions is organized and structured in a uniprofessional, fragmented and disjointed way, which makes it impossible to form a Health Care Network premature infants' perspective.

Hospitalization perceived by children and adolescents undergoing cancer treatment

OBJECTIVE

To know the perception of children and adolescents undergoing cancer treatment about hospitalization.

METHODS

Qualitative research conducted with 13 children and adolescents hospitalized for cancer treatment at a referral hospital in southern Brazil. Semi-structured interviews mediated by the drawing technique were conducted from May to November 2018. Data was submitted to inductive thematic analysis based on the theoretical framework of Brazil's National Humanization Policy.

RESULTS

Disturbances were detected in the professionals' communication with the hospitalized children and adolescents. The participants felt socially isolated and highlighted the importance of recreational activities during hospitalization.

CONCLUSION

Infant cancer is complex and needs multidisciplinary care during the treatment, enabling the organization of healthy and welcoming spaces that favor humanization of care.

Factores asociados al seguimiento del cuidado de niños menores de dos años

Objetivo: analizar los factores asociados al seguimiento adecuado del cuidado infantil en niños meno­res de dos años. Materiales y métodos: estu­dio analítico-transversal desarrolla­do entre noviembre de 2019 y marzo de 2020 en las diez unidades básicas de salud de un municipio del interior de Rio Grande do Sul, Brasil. Partici­paron 71 familiares de niños menores de dos años. Los datos se recopilaron a través de la Herramienta para la Evaluación de la Atención Primaria, versión infantil (PCATool Infantil), e instrumentos de perfil clínico y socioeconómico. Se utilizó estadís­tica analítica, con comparación de frecuencias entre variables. Resultados: el 72 % de los niños menores de dos años tuvieron un seguimien­to adecuado durante las consultas. Los hijos de madres que asistieron a una serie de consultas prenata­les adecuadas tuvieron un número significativamente mayor de consul­tas de cuidado infantil de forma adecuada (p = 0,02). Las familias que no han vivido en medio de vulnera­bilidades sociales y de salud brindan mejor cuidado a los niños (p > 0,05). Cuidadores más jóvenes mostraron mayor adhesión a las consultas. Conclusiones: la adhesión adecua­da de las mujeres gestantes a la aten­ción prenatal, estar bajo la responsa­bilidad de cuidadores jóvenes y no asistir a guarderías o escuelas fueron los factores significativamente más asociados al seguimiento de puericul­tura en niños menores de dos años.

FACTORS ASSOCIATED WITH THE CARE OF CHILDREN AND ADOLESCENTS FOR EXTERNAL CAUSES IN EMERGENCY SERVICE

ABSTRACT Objective to analyze the characteristics of children and adolescents treated for external causes in an emergency service. Method this is a retrospective, analytical study, developed in the emergency department of a sentinel hospital in southern Brazil. Seventy-nine children and adolescents, victims of external causes, participated in June to December 2018. Data were collected through access to medical records in May 2019. Descriptive analysis, frequency comparison and Odds Ratio were used to measure the association between the variables studied. Confidence Interval (CI) of 95% and P value of 5% were used. Results approximately 9.3% of pediatric emergency and emergency care were due to external causes; of these, 57% of the victims are under 12 years old and most of them are male (67%). Accidents are the most frequent events (71%), but violence is more frequent (61%) among women (p=0.002). The chance of violence is four times higher in women, especially self-inflicted violence/suicide attempts. Conclusion one out of ten pediatric emergency care is due to external causes, and emerging situations of violence and self-inflicted injuries stand out, a direct implication for public policies.

Tendência Temporal de Internações por Diagnóstico Oncológico em Crianças e Adolescentes

Introdução: O câncer pediátrico é considerado uma patologia rara, porém requer longos períodos de tratamento em centros de especialidade oncológica. Um dos principais desafios das famílias é o distanciamento dos locais de tratamento e de suporte hospitalar para internações em oncologia pediátrica. Objetivo: Analisar a tendência temporal por locais de residência e internação de crianças e adolescentes por diagnósticos oncológicos, entre os anos de 1998 e 2018, no Estado do Rio Grande do Sul, Brasil. Método: Trata-se de um estudo epidemiológico documental analítico, com coleta de dados secundários em base de dados de domínio público. O estudo possui caráter de série histórica e de distribuição espaço-geográfica, das internações hospitalares de crianças em tratamento oncológico no Rio Grande do Sul. Resultados: Menores de 4 anos representaram a principal demanda de internação por diagnóstico oncológico infanto-juvenil ao longo dos anos. Em cerca de 80% das regiões em saúde, os pacientes acabam internando, por diagnóstico oncológico, fora das suas regiões de saúde e locais de residência. Nos últimos 20 anos, houve aumento da prevalência nas internações, ainda muito localizadas em centros de especialidade. Conclusão: Há necessidade de intervenção de políticas públicas e descentralização de serviços especializados no tratamento e internação em oncologia pediátrica.

Avaliação das condições da pele do recém-nascido em terapia intensiva neonatal

DOI: http://dx.doi.org/10.31011/1519-339X.2018a18n84.3 Objetiva-se avaliar as condições da pele do recém-nascido internado em unidade de terapia intensiva neonatal,segundo a Escala de Condição da Pele do Recém-nascido. Estudo quantitativo, transversal realizado em uma unidadede terapia intensiva neonatal, com a utilização de um formulário de caracterização clínica e da Escala de Condiçãoda Pele do Recém-nascido, sendo sujeitos 47 recém-nascidos. Foram realizadas associações com as variáveis clínicase os escores da escala de condição da pele do recém-nascido. Os dados foram analisados através do Teste Exato deFischer e o Teste de Qui-quadrado corrigido. Para àqueles que permaneceram por mais de sete dias internados foimais evidente a presença de pele seca. Dentre os que nasceram de bolsa rota, 21,3% apresentaram eritema corporal.Dos que permaneceram até sete dias internados, 55,5% apresentaram ruptura/lesão na pele. Conclui-se que osrecém-nascidos que permaneceram mais de sete dias internados apresentaram a pele mais seca. A ruptura/lesãoocorreu na maior parte dos recém-nascidos prematuros e de baixo peso.Palavras-chave: Recém-Nascido; Pele; Cuidados de Enfermagem; Segurança do Paciente; Unidade de TerapiaIntensiva Neonatal. ABSTRACTThe aim is to evaluate the skin conditions of newborns hospitalized in a neonatal intensive care unit accordingto the Newborn Skin Condition Scale. A quantitative, cross-sectional study conducted in a neonatal intensivecare unit, using a clinical characterization form and the Newborn Skin Condition Scale, with 47 newborns. Theanalysis was performed in the Program Statistical Package for the Social Sciences (SPSS) and the Fischer ExactTests and/or Corrected Chi-Square Test were applied. The presence of dry skin was more evident for those whoremained more than seven days hospitalized. Among those born with a broken amniotic membrane, 21.3% hadbody erythema. Those who remained up to seven days in hospital, 55.5% had rupture / skin lesion. It concludesthat the newborns remained more than seven days hospitalized presented the driest skin. The rupture/injuryoccurred in most of the preterm and low birth weight infants.Keywords: Newborn; Skin; Nursing Care; Patient Safety; Neonatal Intensive Care Unit

Stress in Parents of Newborns in a Neonatal Intensive Care Unit

Abstract Objective: To identify the level of stress and the most stressful situations for the parents of newborns hospitalized in a Neonatal Intensive Care Unit. Methods: A descriptive study, with a quantitative approach, performed with parents of newborns admitted to the Neonatal Intensive Care Unit. For the data collection, the Brazilian version of the Parental Stress Scale: Neonatal Intensive Care Unit (PSS: NICU) was used. The analysis was performed using descriptive statistics. Results: The change in the role of mother/father was the subscale in which the highest level of stress was obtained (mean=3.49) and the items considered more stressful in this subscale were "Separated from my baby" (mean=4.00) and "Feeling helpless and unable to protect my baby from pain and painful procedures" (mean=3.78). Conclusion: Hospitalization of a child in a neonatal unit is a stressful experience for parents and there are situations that trigger higher levels of stress.

Factors associated with family risk of children with special health care needs

OBJECTIVE

To identify the factors associated with family risk of children with special health care needs.

METHODS

Bicentric study, with a cross-sectional design and a quantitative approach, with family caregivers of children with special health care needs. Instruments were applied to obtain a sociodemographic characterization, and identify and classify the family risk. For analysis between variables, Mann-Whitney and Fisher's exact tests were used and the Spearman's correlation coefficient was calculated.

RESULTS

One hundred and eighteen caregivers participated in the study. The average family risk score was 3.53 (±3.76), with a median of 3.0, and minimum and maximum values of 0 and 16, respectively, with no significant difference between the two studied Brazilian municipalities. In municipality 1, the number of siblings presented a positive correlation with the average family risk score (0.011, p<0.05). Level of education and marital status of the caregiver showed a significant association with the result (0.038 and 0.002, respectively). The social classification variable presented a negative correlation with the outcome in municipalities 1 (0.003, p<0.01) and 2 (0.006, p<0.01).

CONCLUSION

To classify the family risk and recognize associated factors can be taken as a basis for fair home care to children with special health care needs.