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We regret that this article is behind a paywall., BACKGROUND: Treatment of multidrug-resistant tuberculosis requires long-term therapy with a combination of multiple second-line drugs. These drugs are associated with numerous adverse events that can cause severe morbidity, such as deafness, and in some instances can lead to death. Our aim was to estimate the absolute and relative frequency of adverse events associated with different tuberculosis drugs to provide useful information for clinicians and tuberculosis programmes in selecting optimal treatment regimens. METHODS: We did a meta-analysis using individual-level patient data that were obtained from studies that reported adverse events that resulted in permanent discontinuation of anti-tuberculosis medications. We used a database created for our previous meta-analysis of multidrug-resistant tuberculosis treatment and outcomes, for which we did a systematic review of literature published between Jan 1, 2009, and Aug 31, 2015 (updated April 15, 2016), and requested individual patient-level information from authors. We also considered for this analysis studies contributing patient-level data in response to a public call made by WHO in 2018. Meta-analysis for proportions and arm-based network meta-analysis were done to estimate the incidence of adverse events for each tuberculosis drug. FINDINGS: 58 studies were identified, including 50 studies from the updated individual patient data meta-analysis for multidrug-resistant tuberculosis treatment. 35 of these studies, with 9178 patients, were included in our analysis. Using meta-analysis of proportions, drugs with low risks of adverse event occurrence leading to permanent discontinuation included levofloxacin (1·3% [95% CI 0·3-5·0]), moxifloxacin (2·9% [1·6-5·0]), bedaquiline (1·7% [0·7-4·2]), and clofazimine (1·6% [0·5-5·3]). Relatively high incidence of adverse events leading to permanent discontinuation was seen with three second-line injectable drugs (amikacin: 10·2% [6·3-16·0]; kanamycin: 7·5% [4·6-11·9]; capreomycin: 8·2% [6·3-10·7]), aminosalicylic acid (11·6% [7·1-18·3]), and linezolid (14·1% [9·9-19·6]). Risk of bias in selection of studies was judged to be low because there were no important differences between included and excluded studies. Variability between studies was significant for most outcomes analysed. INTERPRETATION: Fluoroquinolones, clofazimine, and bedaquiline had the lowest incidence of adverse events leading to permanent drug discontinuation, whereas second-line injectable drugs, aminosalicylic acid, and linezolid had the highest incidence. These results suggest that close monitoring of adverse events is important for patients being treated for multidrug-resistant tuberculosis. Our results also underscore the urgent need for safer and better-tolerated drugs to reduce morbidity from treatment itself for patients with multidrug-resistant tuberculosis.

AIM The objective of the current study was to analyze the health outcomes of women attending with a clinical guideline to consultations for cervical cancer (CC) prevention in a primary care center. METHODS A cross-sectional design was used, and data were collected from March to July 2016 with a sample of 87 women in Fortaleza, Brazil. RESULTS The following correlations were found: previous history of sexually transmitted infection (p = 0.025), women who used oral contraceptives (p = 0.035), and undergo the Papanicolaou test annually; having black skin color (p = 0.031) and attending to the first gynecological consultation; being single (p = 0.031), family history of cancer (p

Objective: to analyze the contribution of clinical nursing care to the mother who has recently given birth with immediate postpartum pain based on the Kolcaba's Theory of Comfort. Method: qualitative study by the research-care method. Three nurses, who provided care for women in the immediate puerperium as caregiver-researchers and 30 postpartum women, were admitted to a public maternity hospital. A semi-structured interview was used for data collection, from which the thematic analysis of the content was carried out. Results: nursing care with influences from the biomedical model was observed, but it expresses concern when being cared for. It offers administration of medications, guidelines and non-pharmacological measures for pain relief. Final considerations: nursing care based on the Theory of Comfort contributed to pain relief in the immediate puerperium. RESUMEN Objetivo: analizar la contribución del cuidado clínico de enfermería a la puérpera con dolor en el posparto inmediato, fundamentado en la teoría del confort de Kolcaba. Método: estudio cualitativo, por el método de investigación-cuidado. Participaron tres enfermeras que prestan cuidados a la mujer en puerperio inmediato, como investigadoras-cuidadoras y 30 puérperas, en el posparto inmediato, internadas en una maternidad pública. Se utilizó entrevista semiestructurada para recolección de datos, de los cuales se procedió el análisis temático de contenido. Resultados: se observó la realización de un cuidado de enfermería con influencias del modelo biomédico, pero que expresa preocupación por el cuidado, ofrece administración de medicamentos, orientaciones y medidas no farmacológicas para el alivio del dolor. Consideraciones finales: el cuidado de enfermería fundamentado en la teoría del confort contribuyó para alivio del dolor en el puerperio inmediato. RESUMO Objetivo: analisar a contribuição do cuidado clínico de enfermagem à puérpera com dor no pós-parto imediato, fundamentado na teoria do conforto de Kolcaba. Método: estudo qualitativo, pelo método de pesquisa-cuidado. Participaram três enfermeiras que prestam cuidados à mulher em puerpério imediato, como pesquisadoras-cuidadoras e 30 puérperas, no pós-parto imediato, internadas em uma maternidade pública. Utilizou-se entrevista semiestruturada para coleta de dados, dos quais procedeu-se a análise temática de conteúdo. Resultados: observou-se a realização de um cuidado de enfermagem com influências do modelo biomédico, porém, que expressa preocupação ao ser cuidado, oferece administração de medicações, orientações e medidas não farmacológicas para o alívio da dor. Considerações finais: o cuidado de enfermagem fundamentado na teoria do conforto contribuiu para alívio da dor no puerpério imediato.

This article aimed to identify the scientific evidence about the educational strategies used to promote prenatal health. This is a systematic meta-synthesis. Analysis of published studies revealed the emergence of two central thematic categories: methodological strategies for the educational activities and; educational tools to promote prenatal health. The most used strategy was health education with pregnant women or couples, using conversation circles and focus groups as methods to target the public. The strategies and educational tools used to promote maternal health in prenatal care seek to anchor the expanded concept of health and to contribute to the construction of varied models of health education.

This study aims to identify the actions performed by nurses of the Family Health Strategy with the pregnancy cycle of adolescents and analyze if the actions developed by these nurses are focused on risk prevention in pregnancy and childbirth. It is a qualitative and exploratory research in basic health units with 12 nurses. A semi-structured interview technique was applied, and the speeches were analyzed using content analysis. In the analysis of the results, it was identified two thematic categories in which it was noted that nurses during the prenatal make the reception of pregnant adolescents differently and conduct guidelines on examination, signs and symptoms of possible complications during the pregnancy and still emphasize the importance of educational activities as groups of pregnant women to be a chance of coexistence and exchange of experiences, doubts, and anxieties among themselves. It is concluded that the care provided by nurses is fundamental for the pregnant adolescents having prenatal with more quality.

Objective: to investigate the constituent elements of the nursing consultation in the prenatal care, in the view of the pregnant women. Methods: a qualitative study, undertaken based on semistructured interviews with 95 pregnant women. The samples were chosen by intentional criteria, until theoretical data saturation took place at 25 interviews, which were processed using the ALCESTE software. The participants undertook intercalated prenatal consultations between the nurse and physician. Results: the conduct undertaken in the first prenatal consultation related to arranging tests and the prescription of folic acid and ferrous sulfate, evidencing the importance of attending the consultations. Furthermore, the discourses are based on advice for general care and the filling out of the ‘pregnant woman’s card’ 2 . Conclusion: based on the view of the pregnant women who participated, it was possible to identify that the nursing consultation in the prenatal period was based in technical procedures. Emphasis was placed on the providing of information, but it was not possible to identify feedback on this. Objetivo: compreender os elementos constituintes da consulta de enfermagem no pré-natal na ótica de gestantes. Métodos: estudo qualitativo, desenvolvido a partir de entrevistas semiestruturadas com 95 gestantes. Amostra escolhida por critério intencional, até ocorrência da saturação teórica dos dados, o que ocorreu com 25 entrevistas, processadas no software ALCESTE. As participantes realizavam atendimentos pré- natal intercalados entre enfermeiro e médico. Resultados: a conduta realizada na primeira consulta pré-natal remete-se à solicitação de exames e prescrição das medicações ácido fólico e sulfato ferroso, evidenciando-se importância do comparecimento nas consultas. Além disso, os discursos estão baseados em orientações para cuidados gerais e acerca do preenchimento do cartão da gestante. Conclusão: a partir da ótica das gestantes participantes foi possível identificar que a consulta de enfermagem no pré-natal baseou-se em procedimentos técnicos. Houve ênfase no fornecimento de informações , porém não foi possível identificar feedback acerca destas.

Objective: This study analyzed the concept of "Safe delivery" using the method proposed by Walker and Avant, which establishes eight steps for the construction of a concept. Method: Literature search was carried out in the Virtual Health Library (VHL) and the Scientific Electronic Library Online (Scielo) in the period from April to July 2016. Controlled descriptors were: "Parturition", "Safety" and "Patient safety", in Portuguese and English. The compound term "Safe Delivery" was also used. Thirty two productions were included in this analysis. Results: Among the attributes, maternal and fetal monitoring stand out and, as antecedent, the identification of risks for preventing damage. The reduction of maternal and infant mortality and the well-being of the mother-child binomial were evident in this work. Following the establishment of model case and opposite case, the definition of safe delivery was obtained: "the set of care measures that seek to identify risks, prevent damage and/or complications during delivery, ensuring maternal and fetal monitoring in favor of the welfare of mother and child ". Conclusion: The analysis of the essential attributes, its antecedents and consequences made it possible to define the concept of safe delivery. However, it is considered that this concept is changeable bearing in mind that there is a lack of randomized studies to identify potential risks to childbirth.

Background: Use “Women’s questionnaire” will allow the healthcare professional to meet previously an area in which a woman gets better care during labour and delivery, enabling thus an implementation of strategies for the care and promotion humanized childbirth. On exposed, this research aims to adapt the "Women’s Questionnaire" to the reality of assistance in Ceará. Method: methodological study adopted the procedures recommended in psychometric of face and content validation by seven judges, semantic analysis by 30 mothers and a pre - test involving 30 postpartum women interned in rooming hospital from April to September 2013. It has been considered necessary to have the agreement of at least 80% of the judges for validation, for pertinence and Content Validation Index. Results: This paper shows that most items have been considered clear, comprehensive and relevant by the judges. The final Content Validity Index of the questionnaire was 0.88. The suggestions of the mothers were accepted. Conclusion: The questionnaire finished with 21 items showing up adapted to the reality of the assistance of Ceará, being considered in the context of assistance as a tool to evaluate the care provided to women during labor, delivery and postpartum.

OBJETIVO: Conhecer as percepções de puérperas acerca do cuidado de enfermagem durante o pós-parto imediato. MÉTODOS: Estudo descritivo, qualitativo, realizado no alojamento conjunto de um hospital público de Fortaleza/CE de junho a agosto de 2013. Participaram 25 puérperas por meio de entrevista semiestruturada. Da análise de conteúdo dos dados emergiram duas categorias. O estudo foi aprovado com o parecer nº 314.363. RESULTADOS: Os cuidados de enfermagem apresentaram conotações positivas e negativas, sendo as primeiras salientadas pelas puérperas e traduzidas pelo reforço à autonomia no cuidado de si e do bebê. Como ponto negativo, salientou-se a estrutura precária do alojamento conjunto. CONCLUSÃO: Apesar do cuidado de enfermagem ter sido considerado satisfatório, observa-se a necessidade de mudanças na assistência e estrutura/organização do serviço, para que seja possível prestar um cuidado integral às puérperas e bebês.

This descriptive, qualitative study was performed with the objective to understand the influences that families have on the care for climacteric women. This study was performed in September of 2011, at an outpatient clinic of a public university in the state of Ceara, Brazil. Participants were nine workingwomen of ages between 44 and 57 years. Data were collected in focal groups and by observation, and submitted to content analysis technique as proposed by Bardin(2010). The following categories were developed: influences of families on the care for climacteric women, with positive aspects observed in the demonstration of affection, encouragement, the family’s experience and affection to relieve stress and promote care; and the family’s negative influences, mainly the non-cooperation in housework and relatives’ lack of understanding regarding climacteric complaints. Results suggest an effective implementation of public policies and programs to encourage family participation in issues regarding women’s health and strengthening of families. Descriptors: Nursing; Comprehensive Health Care; Women's Health; Climacteric; Family.

INTRODUCTION: Pregnancy is a physiological phenomenon and therefore its evolution usually occurs uneventfully. However, it can pose risks for both the mother and the fetus and there are a number of women who, due to particular characteristics, are more likely to unfavorable evolution, which are called high-risk pregnancies. Therefore, this study aimed to know, from the narratives of mothers discharged from the Intensive Care Unit, the main doubts and complaints about pregnancy and risk prenatal care and describe the therapeutic itinerary throughout pregnancy. METHOD: Descriptive, qualitative study conducted in the homes of mothers enrolled in basic health services of the 4th Regional Unit in Fortaleza, Ceara, Brazil, from January to February 2015. A total of 10 mothers participated through narrative interview technique. For data analysis, authors adopted the proposal by Gomes and Mendonca and Gomes. RESULTS AND DISCUSSION: Questions were directed to the pathology. The difficulties in the consultation were inadequate communication, focus on disease, difficulty in following guidelines and lack of explanations aimed at childbirth, nutrition, breastfeeding, later childcare and insufficient emphasis on emotional aspects. In addition, there were difficulties along the therapeutic path. CONCLUSION: It was noted the importance of carrying out actions / strategies that enable the realization of a resolute care.

Objective: To identify the pregnant women’s perception before the finding of high-risk pregnancies and the difficulties of access to highrisk prenatal care.Methodology: This is a descriptive and exploratory study with a qualitative approach, conducted with 15 pregnant women at high-risk prenatal care service of a public hospital in Fortaleza/Ceara.Results: Pregnant women reported as difficulties the negligence on availability and assistance of high-risk prenatal service, lack of information about their disease, and the absence of a concrete link to reference and counter reference.Conclusion: The need for a close look at all professionals working in health care services is emphasized, especially those working in primary care for the realization not only of early diagnosis but to charge those responsible for solving referred cases, fulfilling the principles of universality, comprehensiveness and equity.

INTRODUCTION: The puerperal period occurs when starting the restoration of the woman's body after the situation of pregnancy phase, with a transition period in which mothers need to practice self-care for their own benefit, welfare, and health. The care of health professionals in this period should involve guidance to postpartum women, so they understand the importance of taking care of themselves and become able to perform self-care. The aim of this study was to investigate the social representations of puerperal women about self-care and their relationship to the empowerment postpartum. METHOD: This is a descriptive and a qualitative study conducted with 19 mothers from five family health centers. We used the Theory of Social Representations as theoretical and lexical analysis method, using ALCESTE software - version 2012. RESULTS AND DISCUSSION: Self-care of mothers is surrounded by influences, beliefs and practices, which are derived from the experiences of other women in the family and social environment. The contents of the social representations of puerperal women about self-care announce that it is mainly related to the biological dimension of women, valuing the care of the body. CONCLUSION: Nursing must provide the necessary support for the postpartum women, so they feel able to perform self-care and encourage their own empowerment, developing their autonomy, knowledge and skills so they can have greater control over the factors that affect their health and are trained to the practice of self-care.

Objective: to understand the practices adopted by health professionals in the care of parturient women. Methods: qualitative study conducted in a public hospital with 13 health professionals through semi-structured interviews. Narrative data were organized according to content analysis. Scientific evidence for best practices in delivery and birth care according to recommendations of the World Health Organization, were used as reference. Results: two care contexts were raised: the use of practices backed by scientific evidence and routine practices whose evidence is not favorable to use, denoting the adoption of practices derived from beliefs and knowledge of physicians on duty. Conclusion: professionals had their practices backed by scientific evidence, but they still use strategies whose effectiveness is not guaranteed. There is, therefore, a long way to humanize the care provided during childbirth. Objetivo: compreender as práticas adotadas por profissionais de saúde no atendimento à parturiente. Métodos: estudo qualitativo, realizado em uma maternidade pública com 13 profissionais de saúde, a partir de entrevista semiestruturada. Dados narrativos organizados de acordo com o método de análise de conteúdo, tendo como referencial as evidências científicas para boas práticas de atenção ao parto e nascimento, fundamentada nas recomendações da Organização Mundial da Saúde. Resultados: revelaram-se dois contextos assistências: utilização de práticas respaldadas em evidências científicas e práticas rotineiras, cujas evidências não são favoráveis ao uso, o que denota a adoção de práticas oriundas de crenças e saberes de plantonistas. Conclusão: os profissionais apoiavam suas práticas em evidências científicas, porém permaneciam utilizando estratégias cuja eficácia não está garantida, apontando ainda um longo caminho para humanizar a assistência durante a parturição.

Aim: To understand the perceptions of users about the care provided to them and their newborns immediately after childbirth. Method: This is a descriptive study in which a qualitative approach was used, involving 20 postpartum women admitted to a secondary level Public Hospital of Fortaleza. Semi-structured interviews were carried out and were analyzed by means of Bardin’s content analysis technique. Results: Three categories were highlighted: Care provided to newborns; care (or lack of care) provided to postpartum women; and structural failures of the maternity hospital. Discussion: Postpartum care was primarily focused on guidance on breastfeeding, without considering other demands of women, such as: the need for greater attention by the health team; more humane behavior of some health professionals; and guidance on self-care. Conclusion: Postpartum care is still limited and it requires greater attention and commitment from health professionals, as well as adjustments in the structural and organizational conditions of the maternity hospital so that it may provide decent and humane care.

Aim: to analyze the scientific production regarding the nursing care provided to high-risk pregnant mothers. Method: this is an integrative review, performed between September and October 2015 via PubMed, CINAHL, Web of Science, SCOPUS, SciE LO, ME D LI NE , LI LA C S and B D E NF databases, using the key terms “Nursing C are A ND Pregnancy”, and “H igh-Risk”, which resulted in 23 articles. The analysis of data was processed through IRAMUTEQ® software. Results: there were six classes, which represented interfaces of nursing care to high-risk pregnant mothers and that are related to: motivations, specialized care, education, nursing strategies, multi-professional assistance, and context of care. Conclusion: the care of high-risk pregnant mothers was evident through a quality pre-natal and home care, from the plan of individualized care organized by the nurse and by the multi-professional team, under family support and via use of light technologies.

O estudo objetiva dialogar entre os conceitos cuidar e educar e propor uma estratégia de educação em saúde como possibilidade de cuidado clínico de Enfermagem para mulheres no climatério baseada nos princípios educativos de Paulo Freire. Ao longo dos anos, diferentes paradigmas de Educação em Saúde são condicionados por diferentes estratégias, muitas delas reducionistas, o que requer questionamentos e implementação de ações mais integrantes e participativas. A partir deste pensamento, buscamos uma possibilidade de educação que contemple o Outro em sua complexidade, possibilitando que a mulher em sua fase climatérica possa também ser assistida de forma integral. Neste cenário, visualizamos os princípios de Paulo Freire como marco norteador para este desenvolvimento, por ele mostrar uma educação dialogada, solidária, sem arrogância, articulando o saber científico com o conhecimento popular, traduzindo seu método em um trabalho coletivo. The study aims to discuss the concepts of caring and education and propose a strategy for health education as a possibility for clinical nursing care for women in menopause based on the educational principles of Paulo Freire. Over the years, different paradigms of Health Education are conditioned by different strategies, many of them reductionists, which require questioning and implementation of more integral and participatory actions. From this thought, we seek an opportunity for education that includes the "Other" in their complexity, enabling the women in their climacteric phase can also be assisted in full. In this scenario, we visualize the principles of Paulo Freire as a framework to guide this development; it shows a dialectic education, solidarity, without arrogance, articulating the scientific knowledge and popular knowledge, translating his method in a collective work. El estudio objetiva dialogar entre los conceptos cuidar y educar y proponer una estrategia de educación en salud como posibilidad de cuidado clínico de Enfermería para mujeres en el climaterio basada en los principios educativos de Paulo Freire. En el transcurso de los años, diferentes paradigmas de Educación en Salud están condicionados por diferentes estrategias, muchas de ellas reduccionistas, lo que requiere cuestionamientos e implementación de acciones más integrantes y participativas. A partir de este pensamiento, buscamos una posibilidad de educación que contemple al Otro en su complejidad, posibilitando que la mujer en su fase climatérica también pueda ser asistida de forma integral. En este escenario, visualizamos los principios de Paulo Freire como marco orientador para este desarrollo, por mostrar una educación dialogada, solidaria, sin arrogancia, articulando el conocimiento científico con el conocimiento popular, traduciendo su método en un trabajo colectivo.

Objetivou-se apreender as representações sociais de puérperas adolescentes sobre ser mãe na adolescência.Trata de estudo fundamentado na Teoria das Representações Sociais de Moscovici, desenvolvido em um hospitalmaternidadepúblico do município de Fortaleza-CE com 25 puérperas adolescentes através de entrevista semiestruturada.A construção das representações sociais sobre a maternidade na adolescência revela a edificação de opiniões contraditórias.As contradições mais visíveis foram: ser mãe e ser mãe na adolescência, em que a primeira passa a ser concebida como umavirtude, enquanto a segunda estereotipada como prisão através das dificuldades enfrentadas no desenvolvimento dopapel. Conclui-se que a maternidade na adolescência revela a importância de programas educativos sobre a saúde sexual,com enfoque na intersetorialidade entre as escolas, os serviços de saúde e a sociedade para desenvolver mecanismos queidentifiquem e intervenham junto às adolescentes com alto risco para a maternidade precoce.

Objective: To analyze the development of professional skills in an obstetric nursing graduate course. Method: Qualitative research, applying semi-structured interviews with 11 students in the obstetric nursing specialization at the State University of Ceará. Data was submitted to thematic review. Results: According to the subjects, the course offers the development of skills to strengthen and expand the range of activities in obstetric nursing. Despite relying on previous knowledge and experience acquired by the students, there is a gap between the content taught and internship practice, presented as challenges and difficulties faced by the students. The findings suggest a need for curricular revision, incorporating active teaching-learning methodologies, to overcome the disjunction between theory and practice. Final considerations: Students are part of a corpus that is potentially implicated in the construction and transformation of thoughts and values set forth by educational and health institutions, and it is necessary to make changes in political and social organizations, with a focus on providing comprehensive and egalitarian care to the population. RESUMEN Objetivo: Analizar el desarrollo de competencias profesionales en curso de posgrado en Enfermería Obstétrica. Método: Investigación cualitativa, aplicando entrevista semiestructurada a 11 egresados de especialización en Enfermería Obstétrica de la Universidade Estadual do Ceará. Datos sometidos a análisis temático. Resultados: Según visión de los sujetos, el curso brinda desarrollo de competencias que refuerzan y amplían el campo de actuación de la enfermería obstétrica. Aun recurriendo a conocimientos y experiencias previas del alumnado, existe distancia entre los contenidos dictados y la práctica de pasantías, considerados desafíos y dificultades enfrentadas por los egresados. Hallazgos sugieren revisión curricular, incorporando metodologías activas de enseñanza-aprendizaje, superando fragmentaciones teórico-prácticas. Consideraciones finales: Los egresados constituyen un corpus potencialmente implicado en construir y transformar pensamientos y valores de instituciones de salud y enseñanza, necesarios para el cambio en las organizaciones políticas y sociales, apuntando a una atención integral e igualitaria de la población. RESUMO Objetivo: Analisar o desenvolvimento de competências profissionais em curso de pós-graduação em Enfermagem Obstétrica. Método: Pesquisa qualitativa, utilizando entrevista semiestruturada com 11 egressos da especialização em Enfermagem Obstétrica da Universidade Estadual do Ceará. Dados submetidos à análise temática. Resultados: Na ótica dos sujeitos, o curso confere o desenvolvimento de competências que fortalecem e ampliam o campo de atuação da enfermagem obstétrica. Embora resgate o conhecimento prévio dos discentes e as experiências vivenciadas, há distanciamento entre conteúdos ministrados e a prática de estágios, apresentados como desafios e dificuldades enfrentadas pelos egressos. Os achados sugerem revisão curricular, incorporando as metodologias ativas de ensino-aprendizagem, superando a fragmentação entre teoria e prática. Considerações finais: Os egressos se constituem em um corpus potencialmente implicado na construção e transformação de pensamentos e valores das instituições de saúde e ensino, necessários às mudanças nas organizações políticas e sociais, visando atendimento integral e igualitário à população.