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Abstract Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates

Introduction Oral sucrose is repeatedly administered to neonates in the neonatal intensive care unit (NICU) to treat pain from commonly performed procedures; however, there is limited evidence on its long-term cumulative effect on neurodevelopment. We examined the association between total sucrose volumes administered to preterm neonates for pain mitigation in the NICU and their neurodevelopment at 18 months of corrected age (CA).Methods A prospective longitudinal single-arm observational study that enrolled hospitalised preterm neonates

IntroductionUnderstanding human-wildlife interactions is critical to overcoming the socio-environmental crises we face worldwide. Among these interactions, poaching and hunting, human-wildlife conflict, and transmission of zoonotic diseases are major causes of biodiversity loss and detrimental to human well-being. Therefore, this study aimed to analyze wildlife poaching, feral pig hunting, human-wildlife conflict, and health issues in a region of the Brazilian Cerrado, in the state of Mato Grosso do Sul. The study also focused on the lowland tapir (Tapirus terrestris), a poached species listed as vulnerable to extinction.MethodsFrom October 2016 to September 2017, we conducted face-to-face semi-structured interviews with 51 local people from nine stakeholder groups. Interview answers and additional information compiled during the study were evaluated using coding, narrative, and co-occurrence analyses.Results and discussionWe found that the main human-wildlife conflict in the region involves feral pigs, and hunting is practiced as a population control strategy. The lowland tapir is not considered a conflictual species, as it is beloved by most people. However, tapirs are still poached, although less so than in the past, mainly for cultural reasons. Culture was the main motivation behind wildlife poaching in general. We identified 28 species and five taxa currently poached in this Cerrado region, of which 11 are used for medical and aphrodisiac purposes. Historically, wildlife poaching was linked to poor livelihood conditions and lack of support from governmental institutions during the Agrarian Reform process, becoming a cultural habit over the years. Nevertheless, wildlife poaching is less frequent than in the past, and its main barriers are surveillance, poaching prohibition by landowners, and social norm. Therefore, promoting a change in the way people relate to nature, meeting socioeconomic needs, and increasing surveillance appear to be important conservation strategies. Although feral pig hunting may replace wildlife poaching, some hunters still poach wild species, especially peccaries. Hence, it is necessary to keep hunters under surveillance, raise awareness among them, and make them allies in conservation strategies. We found a worryingly low level of awareness about disease transmission risk through bushmeat manipulation and consumption, highlighting the importance of One Health approaches.

OBJECTIVES: Acrodermatitis Enteropathica (AE) is a rare disease that can be transmitted by autosomal recessive inheritance, it can be related to parenteral nutrition without zinc, or it can be secondary to malabsorptive syndromes. Clinically, it is characterized by the triad of acral and periorificial dermatitis, alopecia and diarrhea, accompanied by growth restriction. The condition can be fatal if left untreated. METHODS: We describe the case of a child with AE and Crohns Disease (CD), with AE being a known complication, secondary to malabsorption caused by CD. RESULTS: Treatment for CD was started with systemic steroids, Azathioprine and Mesalazine, and local care with the diaper area. Oral zinc replacement was also started. The child showed significant clinical and dermatological improvement within a few weeks. CONCLUSIONS: The diagnosis of AE is made with serum zinc levels lower than 70 ug/dL. Treatment involves zinc supplementation, at a dose ranging from 1 to 3 mg/kg/day. In the case described, the zinc value was 65 ug/dL. In this case, we started replacement with 2mg/kg/day, with rapid clinical improvement. Zinc deficiency AE is a well-known complication of CD, secondary to malabsorption. In the case described, the cutaneous condition came after the intestinal condition, with the deficiency in the absorption of zinc being secondary to Crohns Disease, leading to a condition with extensive lesions, but with a quick response to the treatment and with an important improvement of the condition.

Abstract. Introduction:. Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2 years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented. Objectives:. To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice. Methods:. This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented. Results:. Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needle-related procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist. Conclusion:. There is evidence of effective pain management strategies for newborns, infants, and toddlers, and a great deal of effort is being made to translate knowledge into action.

Resumo Objetivo Descrever o processo de implementação de uma intervenção multifacetada de tradução e intercâmbio do conhecimento para melhorar as práticas de manejo da dor, e avaliar a adoção desta intervenção pelos profissionais de saúde durante procedimentos dolorosos em neonatos. Métodos Estudo quase-experimental tipo antes e depois, realizado em uma unidade neonatal. A intervenção Evidence-Based Practice for Improving Quality , norteada pela estrutura conceitual The Promoting Action on Research Implementation in Health Services , foi implementada em duas etapas (preparação e implementação), e a sua adoção foi mensurada por indicadores clínicos relacionados ao manejo da dor, apresentados por meio de estatística descritiva. Resultados Após discussão sobre práticas existentes na unidade que necessitavam de mudança; síntese das evidências científicas atuais; e dados do contexto local; os membros do Conselho de Pesquisa e Prática da unidade elaboraram e implementaram metas coerentes e factíveis para mudança da prática no manejo da dor; selecionaram estratégias de tradução e intercâmbio do conhecimento; determinaram o público-alvo e os indicadores e implementaram as intervenções. Houve uma redução em 32,8% no número de procedimentos dolorosos realizados, e aumento entre 26,6 e 50,7% na utilização das escalas de avaliação da dor e de 25,1% na administração da glicose oral. Conclusão A intervenção multifacetada Evidence-Based Practice for Improving Quality é complexa, e possui processos que demandam conhecimento e habilidades, comprometimento dos diversos atores envolvidos, disponibilidade de tempo e investimento financeiro. Os indicadores analisados mostraram que a intervenção resultou em mudanças positivas na prática clínica no manejo da dor do neonato.

Objectives: To characterize a group of university students in social isolation regarding their eating behaviors and to investigate whether dieters have a tendency to engage in binge-eating. Study Design: Cross-sectional study carried out during Brazil’s first months of social isolation. Methods: University students filled out the Eating Attitudes Test—EAT, the Binge-eating Scale—BES, and the Hay questionnaire. In addition, the current research also evaluated food cravings (FC) and intuitive eating. Student’s t-test was used to compare the effect sizes (Cohen’s d) between groups. Results: More than 90% of participants were isolated from academic activities, and 68% reported significant dietary change. Those who dieted (n = 57) were less confident in signs of hunger and satiety (d = −0.9, p < 0.001) and had higher binge-eating and FC levels than those who did not diet. Conclusions: Data reinforces the high prevalence of risk for eating disorders in university students, the impact of dieting on FC, and intuitive eating during social isolation.

O objetivo deste artigo é compreender como o storytelling, ou a contação de histórias, é relevante para a autenticidade. Para tanto, foi desenvolvida revisão de literatura sobre autenticidade em experiências turísticas e sobre storytelling, o que deu base para as discussões teóricas deste estudo. Para que se pudesse alcançar o objetivo proposto, optou-se por uma abordagem interpretativista e qualitativa com trabalho de campo aplicado ao contexto do turismo cacaueiro e chocolateiro na Ilha do Combu, Pará. A coleta de dados se deu por meio de observação e de entrevistas semiestruturadas, e os dados - depois de organizados e transcritos - foram analisados por meio de análise de conteúdo. A partir do acesso aos dados, observou-se que o storytelling proporcionou conexão entre os objetos, o local, as pessoas (incluindo comunidade e prestadores de serviço) e a experiência turística. Nesse sentido, o estudo foi capaz de demonstrar a relação existente entre os elementos da abordagem relacional da autenticidade (Rickly-Boyd, 2012) com o storytelling. Ainda, o estudo permite perceber que as histórias conectam os envolvidos na experiência e seus repertórios, legitimam processos de produção, ilustram aspectos físicos e dão significados a ações.

Abstract Background The clinical Pandemic Practice Champion (PPC) role was created in a large tertiary pediatric hospital as a knowledge translation (KT) strategy for implementing COVID-19 evidence-based knowledge. We aimed to describe the core components of the PPC role, the process of implementing the role, and the factors that hindered or facilitated role implementation. Methods An exploratory case study was undertaken. Semi-structured interviews were conducted virtually with stakeholders including PPC, managers, and front-line health care professionals (HCP). A directed approach to qualitative content analysis consistent with the Consolidated Framework for Implementation Research (CFIR) guided the analytic process. Inductive analyses and three stages of thematic synthesis were also conducted. Results Four PPC, 3 managers, and 6 HCP were interviewed. The core components of the PPC role consisted of (a) acting as knowledge experts and educators, (b) problem-solving for complex patient care issues, (c) conducting crisis management, and (d) acting as a resource to management, HCP, and families. Facilitators for successful implementation included access to external information, a supportive organizational context and culture, dedicated time and resources, and leadership support. Lack of clarity of role definition, insufficient time, pandemic uncertainty and fatigue, inability to change infrastructure, and access to external information hindered implementation. Conclusion The PPC role was successfully implemented within a crisis context. Key barriers (role clarity, time, resources) and facilitators (organizational and leadership support) need to be considered when implementing the PPC role in practice. Future studies are needed to determine the intervention effectiveness of the champion role in changing HCP behavior and health outcomes and further examine implementation processes and mechanisms.

GoalTo determine the analgesic effectiveness of repeated sucrose administration for skin-breaking (SB) procedures over the Neonatal Intensive Care Unit (NICU) hospitalization of preterm infants.MethodsLongitudinal observational study, conducted in four level III Canadian NICUs. Eligible infants were

Abstract The Be Sweet to Babies video demonstrates the analgesic effects of breastfeeding, skin‐to‐skin care, and sweet‐tasting solutions as interventions to reduce pain during blood sampling in newborns. Although effective and safe, these strategies are implemented inconsistently in clinical settings. Given the increasing popularity of social media, there is a potential to disseminate and promote health information through it. The study aim was to evaluate the use of Facebook as a means of disseminating the Be Sweet to Babies video in Portuguese, and to evaluate respondents’ prior knowledge, previous use of the three pain management strategies and intent to use the strategies in the future. We conducted a cross‐sectional study, using the “virtual snowball” sampling method. A Facebook webpage was created, in which the video was posted along with a brief survey. Data analyzed included number of views and visits to the page, number of views of the video, likes, dislikes, and survey responses. One year after posting, the page had 70 753 views and 2199 accesses; there were 1553 “likes”, no dislikes, and 43 positive comments. The survey was completed by 930 respondents (42% response rate based on the page access). Over two thirds of the respondents had previous knowledge about breastfeeding, skin‐to‐skin care, and sweet solutions for pain relief. After watching the video, 87% of the respondents intended to use breastfeeding or skin‐to‐skin care in the future, and 71% intended to use sweet solutions. Almost all viewers rated the video as very useful (n = 917, 99%), easy to understand (n = 926, 99%), and easy to apply in real‐life situations (n = 903, 97%). Using Facebook to deliver and evaluate an intervention is feasible, rapid in obtaining responses, low cost, and it is promising for data collection and knowledge dissemination. Further studies are warranted to evaluate the actual impact of the use of social media in practice change.

Abstract The “Be sweet to babies” video is a knowledge translation tool targeted at parents on the use of analgesic strategies during painful procedures performed in neonates. This study aimed to evaluate the effectiveness of the Portuguese version of this video on maternal involvement in neonatal pain management during the newborn screening blood test. Nonrandomized, pragmatic clinical trial. The study was conducted in a rooming‐in unit. All mothers received a pamphlet regarding neonatal pain management and were invited to participate in daily education sessions conducted by nurses, which included the video. The intervention group included mothers who voluntarily watched the video, while the control group was comprised of mothers who did not attend the education sessions or left the session before watching the video. Data were collected by interviews conducted by the research team. Descriptive and inferential analysis considered a confidence interval of 95%. A total of 73 mothers were included in the study. Analgesic strategies were used in 14 (40%) of the procedures in the intervention group and 9 (24%) in the control group, a clinically important difference of 16% points between groups, although no statistically significant difference was found (P = .13). Breastfeeding was the most commonly used strategy. Watching the video increased the chance of implementing analgesic strategies by 2.1 times (P = .19), while nurses suggesting the use of analgesia increased this chance by 5.5 times (P = .006). Although no statistical significance was found, the results suggest the clinical significance and feasibility of the “Be sweet to babies” video as a KT tool targeted at parents on neonatal pain management during nonurgent painful procedures. In addition, maternal involvement in pain care significantly increased when pain relief strategies were recommended by nurses, which suggests that nurses have a key role in facilitating parental participation.

Abstract The Implementation of Infant Pain Practice (ImPaC) Resource is an eHealth tool designed to support infant pain practice change and ultimately enhance pain outcomes. The aim of this study was to determine users' perspectives on usability, acceptability, and feasibility of the ImPaC Resource. A descriptive prospective mixed‐methods quality improvement study was conducted at a pediatric hospital in Canada. Individual “think aloud” interviews were conducted in a nonclinical environment (Phase A); “near live” testing was conducted while users interacted with the Resource in clinical setting (Phase B); individual “think‐aloud” interviews were conducted in a nonclinical environment (Phase C). Outcomes included usability (System Usability Scale—SUS), acceptability (Acceptability E‐Scale—AES), and feasibility. Interview transcripts were coded per a priori themes using deductive content analysis to create a structured categorization matrix. In Phase A, 10 clinicians interacted with the Resource in individual sessions. Median SUS score was 73.75 (range 52.5‐92.5). In Phase B, four clinicians implemented the Resource in the neonatal intensive care unit (NICU) over 4 months. Median SUS score was 85 (82.5‐92.5), and median AES score was 24 (21‐24). In Phase C, an enhanced prototype was produced, and the same users from Phase B navigated the Resource in individual sessions. Median SUS score was 88.75 (85‐95), and median AES score was 27.5 (25‐29). Users considered the Resource as feasible for implementation, easy to navigate, engaging, intuitive, comprehensive, and evidence‐based. Users highlighted the potential transferability of the Resource to other contexts and settings. The enhanced version of the ImPaC Resource was usable, acceptable, feasible, and met users' expectations and requirements. Results lead the way for evaluation of the Resource in a nationwide cluster randomized trial including 18 NICUs. This knowledge‐rich platform is expected to enhance infant pain practices and outcomes in diverse clinical settings.

Abstract Background Hospitalized infants undergo multiple painful procedures daily. Despite the significant evidence, procedural pain assessment and management continues to be suboptimal. Repetitive and untreated pain at this vital developmental juncture is associated with negative behavioral and neurodevelopmental consequences. To address this knowledge to practice gap, we developed the web-based Implementation of Infant Pain Practice Change (ImPaC) Resource to guide change in healthcare professionals’ pain practice behaviors. This protocol describes the evaluation of the intervention effectiveness and implementation of the Resource and how organizational context influences outcomes. Methods An effectiveness-implementation hybrid type 1 design, blending a cluster randomized clinical trial and a mixed-methods implementation study will be used. Eighteen Neonatal Intensive Care Units (NICUs) across Canada will be randomized to intervention (INT) or standard practice (SP) groups. NICUs in the INT group will receive the Resource for six months; those in the SP group will continue with practice as usual and will be offered the Resource after a six-month waiting period. Data analysts will be blinded to group allocation. To address the intervention effectiveness, the INT and SP groups will be compared on clinical outcomes including the proportion of infants who have procedural pain assessed and managed, and the frequency and nature of painful procedures. Data will be collected at baseline (before randomization) and at completion of the intervention (six months). Implementation outcomes (feasibility, fidelity, implementation cost, and reach) will be measured at completion of the intervention. Sustainability will be assessed at six and 12 months following the intervention. Organizational context will be assessed to examine its influence on intervention and implementation outcomes. Discussion This mixed-methods study aims to determine the effectiveness and the implementation of a multifaceted online strategy for changing healthcare professionals’ pain practices for hospitalized infants. Implementation strategies that are easily and effectively implemented are important for sustained change. The results will inform healthcare professionals and decision-makers on how to address the challenges of implementing the Resource within various organizational contexts. Trial registration ClinicalTrials.gov, NCT03825822. Registered 31 January 2019.

As afecções odontológicas que causam dor aos equinos refletem inadequada trituração do alimento, prejudicando a digestão e predispondo o animal a um emagrecimento progressivo. O presente estudo teve por objetivo avaliar a influência do tratamento odontológico preventivo sobre a deposição de gordura subcutânea e peso de éguas criadas em sistema extensivo. Foram utilizadas 16 éguas, sem raça definida, com idade entre 5 e 15 anos, apresentando escore de condição corporal entre 3 e 4 (escala de 1 a 9), sem histórico de tratamento odontológico prévio. Estes animais foram distribuídos igualmente em dois grupos, sendo o grupo tratado (GT) e o grupo controle (GC). No GT, foi realizada inspeção da cavidade oral e tratamento odontológico. No GC, foi realizada apenas inspeção da cavidade oral. Todos os animais foram pesados com fita torácica e a mensuração da camada de gordura subcutânea foi realizada através do exame ultrassonográfico na base da cauda a cada 30 dias durante cinco meses. Para a avaliação das variáveis, foi utilizado um delineamento inteiramente casualizado, e as médias entre os grupos foram comparadas pelo teste F a 5% de probabilidade para análise de variância (ANOVA). Não foi observada diferença no ganho de peso nem variação na espessura de gordura subcutânea na base da cauda entre os grupos tratado e controle no período de 5 meses. Conclui-se que embora os animais do GT não ganhassem peso comparado ao GC, o tratamento odontológico é considerado um método benéfico na prevenção de muitas afecções do sistema digestivo que poderiam culminar em cólica, também proporciona um melhor aproveitamento dos componentes contidos na dieta, e ainda favorecer o bem-estar animal.

Não se aplica

RESUMO Objetivo: Descrever e quantificar as estratégias farmacológicas e não farmacológicas utilizadas para alívio da dor/estresse de recém-nascidos durante a hospitalização em unidades neonatais. Métodos: Estudo quantitativo, descritivo longitudinal desenvolvido com 50 recém-nascidos admitidos e acompanhados até a alta da unidade neonatal. Resultados: Foram registrados 9.948 procedimentos dolorosos/estressantes, média de 11,25 (± 6,3) por dia por neonato. Foram registradas 11.722 intervenções para controle e alívio da dor, sendo 11.495 (98,1%) estratégias não farmacológicas e 227 (1,9%) farmacológicas. Cada neonato recebeu, em média, 235 intervenções de controle e tratamento da dor em sua hospitalização, sendo 13 intervenções não farmacológicas por dia e uma intervenção farmacológica a cada 2 dias. Conclusão: Os neonatos receberam poucas medidas específicas para o alívio da dor, considerando o elevado número de procedimentos dolorosos e estressantes ao longo da internação. Nesse sentido, considera-se essencial a implementação de protocolos efetivos que visam ao alívio da dor.

ABSTRACT Objective: to analyze skin-to-skin contact practice in full-term newborns after birth. Method: a cross-sectional study carried out in São Paulo-SP with 78 mother-child binomials. Data were obtained from medical records and by non-participant observation. Maternal, neonatal and care conditions, length of skin-to-skin contact and breastfeeding attachment were analyzed. Results: skin-to-skin contact was performed in 94.9% of births, with a mean length of 29 minutes. Births with intact perineum took longer, neonates with Apgar 10, without upper airway aspiration, assisted by a nurse-midwife and with neonatal assistance by a resident in pediatrics. The variables that favor breastfeeding attachment were perineal integrity, newborn with good vitality, without upper airway aspiration and who received professional assistance for breastfeeding attachment. Conclusion: skin-to-skin contact was performed in almost all births, but with less time than recommended as best practice.

O artigo tem por objetivo compreender o movimento de (re)posicionamento da marca de Ilhéus, de destino tradicional de sol e mar para um destino de turismo experiencial chocolateiro. Como base teórica para dar suporte à interpretação dos dados foram adotados os construtos marca de destinos turísticos e turismo experiencial. Para tanto, foi desenvolvida uma pesquisa qualitativa com coleta de dados realizada por meio de entrevistas com quatro gestores locais: o vice-prefeito da cidade, um empresário e presidente do Costa do Cacau Convention and Visitors Bureau, a proprietária da agência de turismo responsável pela comercialização da Costa do Cacau e, por fim, o proprietário de uma fazenda de cacau que recebe turistas. Os dados foram interpretados a partir de uma Análise Temática, que possibilitou observar que o movimento de reposicionamento da marca Ilhéus existe, mas ainda em fase inicial e tímida de mudança. Fez-se, ainda, a partir das entrevistas, um levantamento histórico do turismo na região. Observou-se, por fim, que: a) há concordância entre os entrevistados sobre a relevância do chocolate e do cacau para a identidade do destino; b) há percepção unânime de que Ilhéus possui muita atividade de turismo de massa, em que os visitantes tem pouco conhecimento sobre a cultura e história da região; c) há um movimento de consumidores que visam experiências mais diferenciadas, de busca pelo cacau e pelo chocolate da região; d) há, também, um movimento de criação de oferta de produtos turísticos voltados ao cacau e ao chocolate e ao turismo experiencial na região.

ABSTRACT Objectives: to identify predisposing and enabling factors as well as the health needs associated with the discontinuance of outpatient follow-up of newborns who were hospitalized at neonatal intensive care unit. Methods: cross-sectional study, using the behavioral model of health services use. The study was composed of 358 mothers and newborns referred to the outpatient follow-up after discharge. Characterization, perception of social support, postnatal depression, and attendance to appointments data were collected, analyzed by the R software (3.3.1). Results: outpatient follow-up was discontinued by 31.28% of children in the first year after discharge. In multiple regression analysis, the chance of discontinuance was higher for newborns who used mechanical ventilation (OR = 1.68; 95%CI 1.04-2.72) and depended on technology (OR = 3.54; 95%CI 1.32-9.5). Conclusions: predisposing factors were associated with the discontinuance of follow-up; enabling factors and health needs did not present a significant association. Children with more complex health conditions require additional support to participate in follow-up programs, thus ensuring the continuity of care.

Objetivo: evaluar la adaptación cultural y encontrar evidencias de validez del instrumento tarjetas de cualidad del dolor (ITCD).Materiales y método: estudio metodológico y de validación de pruebas, que para la adaptación y validación de contenido realizó la traducción, retrotraducción, panel de expertos, revisión por niños en edad escolar y prueba piloto del ITCD. Además, se evaluó la validez de criterio externo con 90 niños en edad escolar hospitalizados y con heridas. La investigación fue realizada entre enero y febrero de 2015.Resultados: el instrumento fue traducido y retrotraducido a español y a portugués, respectivamente. En la evaluación del panel de expertos fue establecido un índice de validez de contenido de 0,92. En la revisión realizada por los niños se efectuaron cambios a los descriptores de siete tarjetas según sus sugerencias. El estudio piloto, mostró que 17 tarjetas presentaron claridad semántica para más del 90% de los niños. En cuanto a las evidencias basadas en el criterio externo, las variables diagnóstico médico, tipo de herida, infección de la herida e intensidad del dolor mostraron resultados significativos (p

This paper aims to determine whether, through Orishas and entities, holy fathers and mothers can influence the sacred and profane consumption behavior of the followers of Candomblé and Umbanda in Brazil. With a qualitative research approach, interviews were conducted with practitioners of these religions. The results indicate that holy fathers and mothers directly influence the purchase of sacred and profane by religious followers. However, this influence tends to be stronger in those followers with high involvement with religion. Those with moderate involvement, also buy and follow the guidelines of their deities and entities, if such purchases are related to the sacred aspect. The question that remains is how far these consumers are vulnerable to the guidance given by holy fathers and mothers and are aware of these purchasing choices.

Este ensaio tem o objetivo de fornecer uma lente alternativa para interpretação do construto autenticidade no contexto das experiências turísticas. A revisão de literatura realizada apresenta os principais autores que tratam do tema e suas diferentes perspectivas a respeito de autenticidade, dentre estas a autenticidade objetiva, a construtivista e a existencial. A análise e reflexão dessas diferentes perspectivas oferecem as bases para a proposição da adoção de um solo epistemológico alternativo à interpretação da autenticidade nas experiências turísticas, que pode levar a uma melhor compreensão desse fenômeno. Assim, propõe-se que o Pensamento Complexo de Edgar Morin pode oferecer uma forma complementar para o entendimento da autenticidade no contexto do turismo, na medida em que pode permite ao pesquisador uma alternativa frente ao pensamento fragmentado tradicional que está atrelado a essa temática, e possibilitar reflexões a partir de uma visão mais holística do fenômeno. Essa discussão resultou em proposições, que são discutidas ao final deste trabalho.

ABSTRACT Objective: To analyze the factors associated with non-adherence to the outpatient follow-up of infants discharged from the Neonatal Intensive Care Unit. Method: A cross-sectional study that included 596 children who were discharged between October 1, 2014 and September 30, 2015 and who were referred to outpatient follow-up. The data were collected by evaluating the discharge report and attendance to the consultations. Results: Of the 596 children referred for follow-up, 118 (19.80%) did not attend any outpatient care in the 12 months after discharge. Children with gestational age at birth ≥37 weeks (odds ratio 1.97, p=0.013), who were not resuscitated at birth (odds ratio 1.79, p=0.032) and those without continuous use of medications at home (odds ratio 1.69, p=0.046) were more likely to not adhere to outpatient follow-up. Conclusion: The expressive number of non-adherence to follow-up indicates the need for actions to ensure care continuity to newborns at risk after hospital discharge. Although the differences pointed out cannot be defined as predictors of non-follow-up, evidence of these variables allows us to recognize risks and seek to reduce factors that influence abandoning follow-up care.

O presente estudo teve como objetivo compreender o sistema organizacional de um meio de hospedagem do tipo Cama e Café a partir da relação agência/estrutura, ou seja, da relação entre as pessoas e a estrutura organizacional da empresa. A análise dessa relação buscou avaliar como esses elementos (agente e estrutura) se influenciam a partir do modelo Multidimensional-Reflexivo (ALVES, 2004). Para tanto, buscou-se fundamentação na teoria de Weber, nomeadamente, os conceitos de Ação Social, Tipo Ideal e Estruturas puras de Dominação. Como metodologia, realizou-se um estudo de caso de natureza qualitativa de um meio de hospedagem do tipo Cama e Café. A coleta de dados se deu por entrevistas semiestruturadas, e as informações foram tratadas com a técnica de análise do discurso. Com o resultado da pesquisa verificou-se que existe a supremacia do agente sobre a estrutura na empresa e o subtipo em que se enquadra o ‘cama e café’ é o organizacional-administrativo patriarcal reformista, ou seja, em que o líder da empresa têm autonomia administrativa e é livre da tradição, e, assim, promove mudanças já que a coordenação e o controle são centrados nele.

ABSTRACT. Dória R.G.S., Freitas S.H., Laskoski L.M., Carvalho M.B., Monteiro A.O.N., Camplesi A.C. & Valadão C.A.A. [Clinical evaluation and evolution of colic cases associated with Panicum maximum in Mato Grosso State, Brazil.] Avaliação clínica e da evolução dos casos de cólica associados a Panicum maximum no Estado de Mato Grosso, Brasil. Revista Brasileira de Medicina Veterinária, 37(4):303-308, 2015. Departamento de Medicina Veterinária, Curso de Medicina Veterinária, Faculdade de Zootecnia e Engenharia de Alimentos, Universidade de São Paulo, Av. Duque de Caxias Norte, 225, Centro, Pirassununga, SP 13635-900, Brasil. E-mail: redoria@usp.br An acute disease characterized by colic and timpanism was reported in Pará and Rondônia after horses fed with Panicum maximum cultivars Momba- ça, Tanzânia and Massai pasture grazing. In this study an acute abdomen case was experimentally reproduced after the ingestion of Panicum maximum var Massai pasture based on twenty two clinic and surgical cases of acute timpanic colic cases reported in a farm in the city of Cuiabá – MT, fed with Panicum maximum var Massai pasture, confirming the etiology and accompanying the clinical evolution of the disease. A horse kept in a stall fed only with Massai pasture was daily evaluated and it was verified that the animal presented as result a clinic perfil of pain, high cardiac frequency, respiratory difficulty, intestinal motility absence and exaggerated distention of the stomach and bowels by gas, seeing during the necropsy the stomach and bowels fully distended by gas with liquefied content except by small colon where the feces presented dry and with mucus characterizing the intestinal atony. The necessity of studies that search the identification of the agent responsible for the intestinal atony and gas accumulation in horses fed with Panicum maximum is exposed.

Abstract Aim: The aim of this study was to evaluate the use of the FacebookTM platform as a means of disseminating a video in Portuguese demonstrating the use of three interventions of pain management (breastfeeding, skin-to-skin contact, and sweet solutions) during minor procedures, and to evaluate prior knowledge, the range, dissemination and intent to use the strategies in the future. Method: This is a cross-sectional survey, which used the "virtual snowball" sampling method, aimed at parents and health professionals caring for neonates. The study was conducted in Brazil, through a FacebookTM page (https://www.facebook.com/sejadocecomosbebes), in which the video and a brief questionnaire were posted. Results: After three months the page reached 28,364 "views", in 45 municipalities across Brazil, 1531 people accessed the page, 709 responses to the questionnaires, 1126 "likes", and multiple positive comments. Almost all viewers (99.71%) answered they would use one of the pain reducing strategies. Conclusion: Our results indicate that using FacebookTM to deliver and evaluate an intervention is feasible, rapid in obtaining responses at a low cost, and it is promising for data collection and knowledge dissemination.

RESUMO Objetivo: Descrever o perfil de enfermeiros atuantes em unidades que assistem o recém-nascido, verificar seu conhecimento prévio sobre amamentação, contato pele a pele e soluções adocicadas no alívio da dor procedural neonatal, e avaliar sua percepção sobre a viabilidade, a aceitabilidade e a utilidade do vídeo “Seja Doce com os Bebês”. Método: Estudo transversal, realizado em quatro unidades de um hospital universitário de São Paulo. Foram incluídos 45 enfermeiros, que responderam ao questionário de caracterização e assistiram ao vídeo. Posteriormente, 38 avaliaram o vídeo. Estatística descritiva foi utilizada para análise das variáveis, além da análise de conteúdo na questão aberta. Resultados: Participaram do estudo 45 enfermeiros. 97,4% conheciam as estratégias analgésicas e, após assistirem ao vídeo, afirmaram pretender utilizá-las ou incentivar seu uso durante procedimentos dolorosos. Todos recomendariam o vídeo para outros profissionais, sendo o recurso avaliado como útil, fácil de entender e de aplicar em situações reais. Conclusão: Os enfermeiros conhecem as estratégias analgésicas, consideram o vídeo viável, aceitável e útil como ferramenta de tradução do conhecimento para profissionais da saúde, o que também pode favorecer o envolvimento dos pais no manejo da dor de seus filhos.

OBJECTIVE Identify resources that support learning mediated by technology in the field of neonatal nursing. METHOD Systematic review with searches conducted in MEDLINE, LILACS and SciELO. Titles and abstracts were independently evaluated by two experts. RESULTS Of the 2,051 references, 203 full-text articles were analyzed, resulting in the inclusion of nine studies on semiotics and semiology, cardiopulmonary resuscitation, general aspects of neonatal care, diagnostic reasoning and assessment of pain. Only two articles addressed the development of educational strategies and seven papers described the assessment of these strategies by experts and/or users. CONCLUSION Distance education is an important resource for education, and its improvement and updating, and it particularly adds advantages for neonatal nursing by approximating teaching and real-life situations and by minimizing the exposure of newborns for teaching purposes. The lack of educational initiatives mediated by technology suggests the need for the development, evaluation and dissemination of educational resources focused on nursing care of newborns and their families.

ABSTRACT. Laskoski L.M., Fioravanti R.A.B., Doria R.G.S., Carvalho M.B. & Freitas S.H. [Generalized subcutaneous emphysema in a horse afte axillary wound - A case report.] Enfisema subscutâneo generalizado em um equino após ferida axilar - Relato de caso. Revista Brasileira de Medicina Veterinária, 37(1):93-96, 2015. Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Paraná, Campus Curitiba, Rua dos Funcionários, 1540, Curitiba, PR 83035-050, Brasil. Email: luciane-laskoski@hotmail.com Subcutaneous emphysema in horses may have different origins, and the most common are perforations of trachea and cutaneous tissue in regions of intense movement, wich leads to suction of air into the subcutaneous space. This report is about the care of a horse with generalized subcutaneous emphysema secundary to wound in the axilla, whose improvement was daily dressing, antibiotic therapy and restriction of movement. One week after initiation of treatment there was a complete reduction of subcutaneous emphysema, and the wound healed completely after three weeks. We conclude that emphysema secondary to skin wounds have a good prognosis if treated properly.

ABSTRACT Objective: to determine the frequency of pain, to verify the measures adopted for pain relief during the first seven days of hospitalization in the Neonatal Intensive Care Unit and to identify the type and frequency of invasive procedures to which newborns are submitted. Method: cross-sectional retrospective study. Out of the 188 hospitalizations occurred during the 12-month period, 171 were included in the study. The data were collected from the charts and the presence of pain was analyzed based on the Neonatal Infant Pain Scale and on nursing notes suggestions of pain. For statistical analysis, the Statistical Package for the Social Sciences was used, and the significance level was set at 5%. Results: there was at least one record of pain in 50.3% of the hospitalizations, according to the pain scale adopted or nursing note. The newborns underwent a mean of 6.6 invasive procedures per day. Only 32.5% of the pain records resulted in the adoption of pharmacological or non-pharmacological intervention for pain relief. Conclusion: newborns are frequently exposed to pain and the low frequency of pharmacological or non-pharmacological interventions reinforces the undertreatment of this condition.

BACKGROUND AND OBJECTIVES:Hospitalized newborns are often submitted to painful and stressing procedures. Adequately measuring and evaluating pain favor its control in this population. For such, education and training strategies are important, emphasizing computer-based technology, which involves software, multimedia packages and network connection. This article aimed at describing the Neonatal Pain Assessment Program II.CASE REPORT:The platform used to host the Neonatal Pain Assessment Program II is the Modular Object-Oriented Dynamic Learning Environment (Moodle). The program is made up of eight modules addressing contents regarding pain anatomy and physiology, neonatal pain indicators, use of pain evaluation tools, in addition to detailed explanations of four specific tools to evaluate newborn pain. Resources such as audio presentations, formative evaluation exercises with photos and videos, texts for additional reading and discussion forums are also used.CONCLUSION:Computer-based teaching may be considered important knowledge translation facilitator. So, we believe that this initiative, considered novel and innovative, shall favor the use of clinical evidences in different neonatal assistance scenarios, as well as shall enhance knowledge and skills of health students and professionals with regard to neonatal pain evaluation.

Objetivou-se caracterizar as estratégias de analgesia e sedação em neonatos submetidos à instalação do cateter central de inserção periférica (CCIP) e relacioná-las ao número de punções venosas, duração do procedimento e posicionamento da ponta do cateter. Estudo transversal com coleta prospectiva de dados, realizado em uma unidade de cuidados intensivos neonatais de um hospital privado na cidade de São Paulo, no período de 31 de agosto de 2010 a 01 de julho de 2011, em que foram avaliadas 254 inserções do CCIP. A adoção de estratégias analgésicas ou sedativas ocorreu em 88 (34,6%) instalações do cateter e não esteve relacionada ao número de punções venosas, duração do procedimento ou posicionamento da ponta do cateter. As estratégias mais frequentes foram a administração endovenosa de midazolam em 47 (18,5%) e fentanil em 19 (7,3%) inserções do cateter. Recomenda-se maior adoção de estratégias analgésicas antes, durante e após o procedimento.

O estágio de doutorado no exterior, conhecido, no Brasil, como "Doutorado Sanduíche", é uma oportunidade de aprimorar as habilidades em pesquisa, destacar-se no meio acadêmico e estabelecer e/ou ampliar oportunidades de trabalho em contexto internacional. Neste artigo, descrevemos elementos-chave do processo de planejamento e desenvolvimento do Doutorado Sanduíche aprendidos por professores e alunos envolvidos na colaboração entre a Escola de Enfermagem da Universidade de São Paulo e a Lawrence S. Bloomberg Faculty of Nursing, Universidade de Toronto, Canadá, e apresentamos a participação em uma rede de doutorados, como alternativa ao Doutorado Sanduíche. A experiência internacional, quando bem planejada e desenvolvida, promove o desenvolvimento pessoal e profissional do aluno, favorece a internacionalização dos programas de pós-graduação e dos grupos de pesquisa brasileiros.Una estancia de doctorado internacional, "Doctorado Sándwich" como es conocido en Brasil, es una oportunidad de mejorar las habilidades de investigación, hacerse conocido académicamente y establecer y/o agrandar las oportunidades de trabajo en el contexto internacional. En este artículo, nosotros describimos factores importantes del proceso de la planificación y desarrollo del "Doctorado Sándwich" aprendidos por estudiantes y profesores involucrados en la colaboración entre la Escuela de Enfermería de la Universidad de São Paulo y la Facultad de Enfermería Lawrence S. Bloomberg, Universidad de Toronto, Canadá y presentamos la participación en una red de doctorados como una alternativa a la estancia doctoral internacional. La experiencia internacional, cuando bien planeada y desarrollada, promueve el desarrollo personal y profesional del estudiante y favorece la internacionalización de los programas de postgrado y de los grupos de investigación brasileños.International PhD internship, named "Sandwich PhD'" in Brazil, is an opportunity to improve research abilities, to become known in academic area and to establish and/or increase work opportunities in an international context. In this article, we describe key factors regarding the planning and development of the "Sandwich PhD" as experienced by professors and students involved in the collaboration between the School of Nursing, University of São Paulo and Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. We also present the participation of PhD students' network as an alternative to the "Sandwich PhD". An international experience, when well-planned and developed correctly, promotes students' personal and professional development and favors the internationalization of Brazilian graduate programs and research groups.

BACKGROUND: Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized.

El objetivo del estudio fue traducir y adaptar la versión del Premature Infant Pain Profile para el portugués de Brasil. Es un estudio transversal y metodológico para validación de la tradición de instrumento. El proceso se llevó a cabo en cuatro etapas: traducción inicial, síntesis, re-traducción y análisis por jueces. Se establecieron cuatro versiones distintas del instrumento traducido al portugués y una versión sintética fue producida a partir de traducciones anteriores. Posteriormente, dos versiones fueron re-traducidas independientemente y no mostraron diferencias importantes del original. Un comité de jueces revisó la versión resumida y las retraducciones con respecto a la equivalencia semántica y idiomática y consideraron adecuada la versión del instrumento en portugués. El instrumento Perfil da Dor no Recém-Nascido Pré-termo fue considerado adaptado al idioma portugués, para su aplicación en la investigación y en la práctica clínica. Esto contribuye, especialmente, para la internacionalización de los resultados de la investigación en Brasil.

O objetivo do estudo foi Identificar os fatores preditivos e os sinais de taquipnéia transitória neonatal valorizados por enfermeiras de unidade neonatal e alojamento conjunto ao avaliar a função respiratória do recém-nascido no período neonatal imediato. Estudo transversal realizado em duas instituições hospitalares públicas da cidade de São Paulo. Participaram do estudo 28 enfermeiras que responderam um questionário estruturado relacionado às práticas de avaliar a função respiratória do neonato. As enfermeiras consideram relevantes conhecer a evolução do trabalho de parto, parto e o Apgar ao avaliar a função respiratória do neonato. Com relação aos sinais clínicos valorizam o monitoramento da freqüência respiratória, ausculta pulmonar, avaliação do nível de desconforto respiratório utilizando o Índice de Silverman-Andersen, além desses, as enfermeiras de unidade neonatal valorizaram o monitoramento da saturação de oxigênio.El objectivo del estudio fue identificar los factores predictivos y los señales de tachypea transitoria del niño valorado por las enfermeras de unidad neonatal y alojamiento conjunto al evaluar la función respiratoria del recién-nascido en el período de neonatal inmediato. Estudio transversal conducido en dos hospitales públicos de la ciudad de São Paulo. Participaran del estúdio 28 enfermeras que responderan un cuestionario estructurado sobre la práctica de evaluar la función respiratorio del niño. Las enfermeras consideran relevante conocer la evolución del trabajo del parto, parto y el escore de Apgar del recién-nacido. Con relación a los señales clinicos, las enfermeras valoraram el monitoramiento de la frecuencia respiratoria, ausculta pulmonar y evaluación de disfunción respiratoria utilizando el Index de Silverman-Andersen. Las enfermeras neonatales también valoraram el monitoramiento de la saturación de oxígeno.The aim of the study was to identify the predictive factors and the signals of transient tachypnea of the newborn valued by the nurses who work at neonatal ward and rooming-in when they assess the newborn respiratory function during the immediate neonatal period in the first six hours after birth. A cross sectional study carried out at two public hospitals of São Paulo city. The sample consisted of 28 nurses who replied a structured questionnaire about the newborn respiratory function assessment practices. Data showed they valuated to know the evaluation of labor, delivery and Apgar score when they evaluate the newborn respiratory function. About the signals of respiratory distress they valued to evaluate the respiratory rate and auscultation, evaluation of the respiratory distress using the Silverman-Andersen Index besides, the neonatal nurses valued to evaluate de oxygen saturation.

O estudo é uma revisão narrativa de teses e dissertações concluídas no período de 2000 a 2009 produzidas pelo Grupo de Pesquisa Enfermagem Obstétrica e Neonatal e pelo Núcleo de Estudos e Pesquisa em Aleitamento Materno da Escola de Enfermagem da Universidade de São Paulo que focalizaram os fatores maternos e perinatais que repercutem na saúde neonatal. A produção científica evidencia alinhamento com as diretrizes estabelecidas pelos órgãos de saúde nacionais e internacionais para a promoção da saúde neonatal e infantil.El estudio es una revisión de la literatura de tesis y disertaciones producidas en el periodo de 2000 hasta 2009 por el Grupo de Investigación de Enfermería Obstétrica y Neonatal y por el Centro de Estudios y Investigación en Lactancia Materna de la Escuela de Enfermería de la Universidad de São Paulo, que se centró en las repercusiones maternas y perinatales en la salud del recién nacidos. La producción científica se muestra de acuerdo con las directrices para promover la salud neonatal y infantil establecidas por los organismos de salud nacionales e internacionales.The study is a literature review of theses and dissertations concluded from 2000 to 2009 developed by the Obstetric and Neonatal Nursing Research Group and Breastfeeding Center for Studies and Research of Nursing School, University of São Paulo, which focused on the maternal and perinatal impact on neonatal health. The scientific production shows agreement with the guidelines to promote neonatal and infant health established by national and international health agencies.

INTRODUCTION: It is important to know the reasons for resubmitting research projects to the Research Ethics Committee in order to help researchers to prepare their research projects, informed consent forms and needed research documentation. OBJECTIVES: To verify the reasons for resubmitting projects that were previously rejected by the Ethics Committee. METHOD: This is a cross-sectional study that evaluated research projects involving human beings. Research projects were submitted in 2007 to the Research Ethics Committee of the Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. RESULTS: One thousand two hundred and fifty six research projects were submitted to the ethics committee and the average time for evaluating the research projects and related documents until a final decision was reached was 49.95 days. From the total, 399 projects were reviewed in 2 or more meetings until a final decision was reached. Of these, 392 research projects were included in the study; 35 projects were subsequently excluded for involving animals. Among the research projects included, 42.5% concerned research with new drugs, vaccines and diagnostic tests, 48.5% consisted of undergraduate students' research projects, 68.9% of the research had no sponsorship, and 97.5% were eventually approved. The main reasons for returning the projects to the researchers were the use of inadequate language and/or difficulty of understanding the informed consent form (32.2%), lack of information about the protocol at the informed consent form (25.8%), as well as doubts regarding methodological and statistical issues of the protocol (77.1%). Other reasons for returning the research projects involved lack of, inaccuracy on or incomplete documentation, need of clarification or approval for participation of external entities on the research, lack of information on financial support. CONCLUSION: Among the research projects that were returned to the researchers for additional clarification, the main reasons were inadequacies or doubts about the terms used in the informed consent form as well as lack of information regarding the research at the informed consent form and methodological and statistical issues regarding the protocol.

OBJETIVOS: avaliar a presença de dor durante a fisioterapia respiratória em prematuros submetidos à ventilação mecânica. MÉTODOS: estudo prospectivo realizado entre fevereiro de 2003 e maio de 2004, sendo incluídos prematuros com idade gestacional OBJECTIVES: to assess pain in premature newborns undergoing mechanical ventilation during respiratory physiotherapy. METHODS: prospective study from February 2003 to May 2004, covering premature newborns with a gestational age of

The objectives of this study were to verify the frequency of pharmacological analgesia and the occurrence of postoperative pain in neonates undergoing cardiac surgery. METHODS: This is a cross-sectional study and data were collected from 30 medical charts of neonates who underwent cardiac surgery in a private hospital in the city of São Paulo. RESULTS: The majority (96.6%) of neonates received analgesia: 18 (60.0%) received continuous analgesics, five (16.7%) received intermittent drugs, and six (20.0%) received a combination of continuous and intermittent analgesics. Fentanyl citrate was continuously administered to 24 (80.0%) neonates. Intermittent dipyrone and morphine was administered to ten (33.3%) and one (3.3%) neonates, respectively. Pain registers were observed in 17 (56.7%) medical charts and the occurrence of pain among neonates who received analgesics was 53.4%. CONCLUSION: There was no efficacy in pharmacological postoperative pain control in the neonates included in this study.Los objetivos de este estudio fueron verificar la frecuencia de cobertura analgésica farmacológica y la aparición de dolor postoperatorio en neonatos sometidos a la cirugía cardiaca. MÉTODO: Se Trata de un estudio transversal con recolección de datos de Historias Clínicas de 30 neonatos sometidos a cirugía cardiaca en un hospital privado de la ciudad de San Pablo. RESULTADOS: La frecuencia de cobertura analgésica fue de 96,6%, 18(60,0%) recibieron analgesia continua, cinco (16,7%) intermitente y seis (20,0%) intermitente y continua. El citrato de fentanil fue administrado continuamente a 24 (80,0%) neonatos. Dipirona y morfina fueron administradas en dosis intermitentes a diez (33,3%) y a un (3,3%) neonatos, respectivamente. Fueron identificados registros de ocurrencia de dolor en 17 (56,7%) Historias Clínicas. La ocurrencia de dolor postoperatorio en recién nacidos con cobertura analgésica fue 53,4 %. CONCLUSIÓN: los datos apuntan que el abordaje analgésico adoptado se mostró ineficaz para controlar el dolor postoperatorio en los neonatos estudiados.Os objetivos deste estudo foram verificar freqüência de cobertura analgésica farmacológica e ocorrência de dor pós-operatória em neonatos submetidos à cirurgia cardíaca. MÉTODO: Estudo transversal com coleta de dados de prontuários de 30 neonatos submetidos à cirurgia cardíaca em um hospital privado da cidade de São Paulo. RESULTADOS: a freqüência de cobertura analgésica foi de 96,6%, 18(60%) receberam analgesia contínua, cinco (16,7%) intermitente e seis (20%) intermitente e contínua. O citrato de fentanil foi administrado continuamente a 24 (80%) neonatos. Dipirona e morfina foram administradas em doses intermitentes a dez (33,3%) e um (3,3%) neonato, respectivamente. Foram identificados registros de ocorrência de dor em 17 (56,7%) prontuários. A ocorrência de dor pós-operatória em recém-nascidos com cobertura analgésica foi 53,4%. CONCLUSÃO: os dados apontam que a abordagem analgésica adotada mostrou-se ineficaz para controlar a dor pós-operatória nos neonatos estudados.

Estudo transversal cujo objetivo foi descrever o perfil dos recém-nascidos submetidos à cirurgia cardíaca em um hospital privado, referência em cirurgia cardíaca neonatal, no município de São Paulo. Foram analisados prontuários de 30 pacientes internados entre julho de 2001 a dezembro de 2005. Foram incluídos neonatos com idade > 35 semanas, com anomalias cardíacas. Excluíram-se os neonatos com óbito no 1. pós-operatório (OP) e com outras malformações sistêmicas. A maioria dos RNs nasceu a termo, com peso > a 2.500g e submetidos à cirurgia na primeira semana de vida. Foram identificados 24 diferentes diagnósticos de cardiopatias e 14 diferentes intervenções cirúrgicas. No 1. PO, todos os neonatos estavam com dispositivos para monitorar os parâmetros vitais ou como via de acesso para tratamento e suporte de vida, mostrando não só a complexidade do tratamento, como a necessidade de planejamento e organização do serviço na implementação da assistência a estes pacientes.El objetivo en este estudio transversal fue caracterizar a los recién nacidos sometidos a cirugía cardiaca en un hospital privado del municipio de Sao Paulo. Los dados fueron obtenidos de las historias clínicas de los recién nacidos sometidos a cirugía entre julio de 2001 y diciembre del 2005. Los recién nacidos con 35 semanas o más de gestación fueron incluidos y excluidos los recién nacidos con óbito en el 1er dia de post-operatorio (PO) y con otras malformaciones sistémicas. La mayoría de los RNs nació a término, con peso a 2.500g e sometidos a la cirugía en la primera semana de vida. Fueron identificados 24 diferentes diagnósticos de cardiopatías y 14 diferentes intervenciones quirúrgicas. En el 1er dia de PO, todos los neonatos estaban con dispositivos para monitorear los parámetros vitales o como vía de acceso para el tratamiento y soporte de vida, mostrando no sólo la complejidad del tratamiento, sino también la necesidad de planificación y organización del servicio en la implementación de la asistencia a estos pacientes.The aim of this cross-sectional study was to characterize newborns that underwent cardiac surgery in a private hospital, a reference center in neonatal cardiac surgery, in the city of São Paulo. Data were collected from medical reports from July, 2001 to December, 2005. Newborns with gestational age of more than 35 weeks were included in the study. Newborns that died on the first 48 postoperative hours and with other malformations were excluded. Most of the neonates were term, weighted 2,500 grams or more, and underwent surgery in the first week of life. There were 24 different diagnoses identified and 14 different types of surgery performed. In the first post-operative day, all newborns had invasive devices for vital signs monitoring or for treatment and life support, which shows not only the complexity of the treatment but the need for planning and organizing health services in order to provide adequate care for these patients.

Objetivou-se relatar e discutir as experiências de um grupo de professores e alunos de graduação de Medicina sobre os estágios de iniciação científica, realizados por meio de projetos de pesquisa com métodos qualitativos, parte deles tendo a Atenção Primária à Saúde como campo de pesquisa. Contextualizando o relato, acentuou-se a história relativamente recente da iniciação científica no Brasil e, em nível mundial, a também recente utilização em mais ampla escala dos métodos qualitativos em saúde. O relato de experiência se estruturou a partir do fluxograma do processo de trabalho seguido pelos estágios de iniciação científica. Destacou-se ter havido uma relativa autonomia dos estudantes em relação à coleta de dados, mas, por outro lado, maior dependência em relação aos seus orientadores no momento de analisar e interpretar os achados. Por meio desses estágios, acredita-se que se valoriza a rede de significados presentes no processo saúde-doença-cuidado, em particular na Atenção Primária à Saúde, considerando que uma progressiva compreensão científica desse processo complexo ajuda a aperfeiçoar uma prática médica atenta às plenas necessidades de pacientes e comunidades.

ABSTRACT Objective: To characterize painful procedures, analgesic strategies, vital signs, and pain scores in hospitalized newborns. Method: This is a primary, observational, prospective clinical study, developed in a Brazilian public hospital. Demographic data, painful procedures, pain relief measures, vital signs, and pain scores were collected from the clinical records of 90 newborns admitted to the intensive care unit and evaluated between admission and the third day of admission. For statistical analysis, the software Statistic Package for the Social Sciences and the R Software were used. Results: Newborns underwent 2,732 painful procedures, 540 non-pharmacological and 216 pharmacological strategies. The most frequently performed procedure was the heel prick (20.96%). The most commonly recorded non-pharmacological strategy was dim lighting (28.33%) and continuous fentanyl (48.83%) was the main pharmacological measure adopted. Pain score and vital signs show variability in the period evaluated. Conclusion: Despite the high number of painful procedures, pain assessment records do not reflect procedural pain and the use of analgesic strategies was insufficient.

ABSTRACT Objective: To determine the prevalence of recurrent wheezing (RW) in preterm infants who received prophylaxis against severe infection with respiratory syncytial virus (RSV) and to identify genetic susceptibility (atopy or asthma) and risk factors for RW. Methods: This was a cross-sectional study involving preterm infants who received prophylaxis with palivizumab at a referral center in Brazil during the first two years of age. A structured questionnaire was administered in a face-to-face interview with parents or legal guardians. Results: The study included 410 preterm infants (median age = 9 months [0-24 months]). In the sample as a whole, 111 children (27.1%; [95% CI, 22.9-31.5]) had RW. The univariate analysis between the groups with and without RW showed no differences regarding the following variables: sex, ethnicity, maternal level of education, gestational age, birth weight, breastfeeding, number of children in the household, day care center attendance, pets in the household, and smoking caregiver. The prevalence of RW was twice as high among children with bronchopulmonary dysplasia (adjusted OR = 2.08; 95% CI, 1.11-3.89; p = 0.022) and almost five times as high among those with a personal/family history of atopy (adjusted OR = 4.96; 95% CI, 2.62-9.39; p < 0.001) as among those without these conditions. Conclusions: Preterm infants who received prophylaxis with palivizumab but have a personal/family history of atopy or bronchopulmonary dysplasia are more likely to have RW than do those without these conditions.

ABSTRACT Objectives: to assess layout quality, visual identity and content of the “Neonatal Pain Assessment Program” (Programa de Avaliação da Dor Neonatal) online course. Methods: a descriptive exploratory study. The course was assessed by 24 experts in pain, neonatology and education. A form containing 20 questions on technical, interface and educational aspects was used. For each item, the score ranged from 0 to 1. Mean scores above 0.7 were considered indicative of high quality of the items. Descriptive statistics were used for data analysis. Results: navigation, clarity, ease of localization, content relevance, contextualization, content correction, multiple windows, ease of use, ease of return, ergonomics, esthetics, special brands, audiovisual resources, information and portability were assessed. All aspects obtained a mean ≥ 0.70 and no changes were required. Conclusions: the Neonatal Pain Assessment Program is considered as quality educational technology and promising strategy for health education.