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Objectives: to analyze the association between nursing workload and neonatal mortality risk in newborns admitted to the Neonatal Intensive Care Unit. Methods: this is an observational, cross-sectional study conducted from January 2019 to January 2020. Results: the sample consisted of 399 newborns, 55.4% male, Nursing Activities Score mean of 67.5%, and Score for Neonatal Acute Physiology Perinatal Extension mean of 17.7, revealed itself as a predictor of the risk of death, while gestational age, length of hospitalization, and the first-minute Apgar established a protective relationship. The correlation between workload and neonatal mortality was low (r= 0.23, p=0.0009). Conclusions: the workload of the nursing team is not associated with the risk of mortality in the Neonatal Intensive Care Unit, as measured by the Nursing Activities Score. RESUMEN Objetivos: analizar la relación entre la carga de trabajo de enfermería y el riesgo de mortalidad neonatal en recién nacidos internados en Unidad de Cuidados Intensivos Neonatal. Métodos: estudio observacional, del tipo transversal, realizado en el período de enero de 2019 a enero de 2020. Resultados: la muestra se constituyó de 399 recién nacidos, siendo 55,4% del sexo masculino, Nursing Activities Score mediano de 67,5% y Score for Neonatal Acute Physiology Perinatal Extension mediano de 17,7, se mostró como pronosticador para riesgo de óbito, mientras la edad gestacional, tiempo de internación y Apgar del primero minuto establecieron una relación protectora. La correlación entre carga de trabajo y el riesgo de mortalidad neonatal fue baja (r= 0,23, p=0.0009). Conclusiones: la carga de trabajo del equipo de enfermería, mensurada por el Nursing Activities Score, no está relacionada al riesgo de mortalidad en el ámbito de la Unidad de Cuidados Intensivos Neonatal. RESUMO Objetivos: analisar a associação entre a carga de trabalho de enfermagem e o risco de mortalidade neonatal em recém-nascidos internados em Unidade de Terapia Intensiva Neonatal. Métodos: trata-se de um estudo observacional, do tipo transversal, realizado no período de janeiro de 2019 a janeiro de 2020. Resultados: a amostra constituiu-se de 399 recém-nascidos, sendo 55,4% do sexo masculino, Nursing Activities Score médio de 67,5%, Score for Neonatal Acute Physiology Perinatal Extension médio de 17,7 e mostrou se como preditor para risco de óbito, enquanto a idade gestacional, tempo de internação e Apgar do primeiro minuto estabeleceram uma relação protetora. A correlação entre carga de trabalho e o risco de mortalidade neonatal, foi baixa (r= 0,23, p=0.0009). Conclusões: a carga de trabalho da equipe de enfermagem, mensurada pelo “Nursing Activities Score”, não está associada ao risco de mortalidade no âmbito da Unidade de Terapia Intensiva Neonatal.

Objective To evaluate the effects of vitamin D supplementation in the postpartum period of women with previous gestational diabetes mellitus (GDM). Methods Randomized clinical trials of pregnant women with GDM of any chronological, gestational age and parity, with no history of previous disease who received vitamin D supplementation in the prenatal and/or postpartum period and were evaluated in the postpartum period were included. The PubMed, EMBASE, Cochrane, and LILACS databases were consulted until July 2019. Serum vitamin D concentration (25- hydroxyvitamin D in nmol/L), fasting blood glucose, glycated hemoglobin, serum calcium concentration, homeostatic model assessment of insulin resistance (HOMAIR), quantitative insulin sensitivity check index (QUICKI), parathyroid hormone (PTH) and body mass index (BMI) were evaluated. Similar results in at least two trials were plotted using the RevMan 5; Cochrane Collaboration, Oxford, Reino Unido. The quality of the evidence was generated according to the classification, development, and evaluation of the classification of the recommendations. Results Four studies were included in the present review (200 women). The findings indicate that there is no difference in the postpartum period in women diagnosed with previous GDM who received vitamin D supplementation in the prenatal and/or in the postpartum period, showing only that there was a significant increase in the concentration of vitamin D (relative risk [RR]: 1.85; 95% confidence interval [CI]: 1.02-2.68). Conclusion This increase in the concentration of vitamin D should be interpreted with caution, since the assessment of the quality of the evidence was very low. For the other analyzed outcomes, there was no significance between the intervention and control groups, and the outcomes, when analyzed in their strength of evidence, were considered very low and low in their evaluation. Resumo Objetivo Avaliar os efeitos da suplementação de vitamina D no pós-parto de mulheres com diabetes mellitus gestacional (DGM) anterior. Métodos Foram incluídos ensaios clínicos randomizados com gestantes com GDM de qualquer idade cronológica, gestacional e paridade, sem história de doença prévia, que receberam suplementação de vitamina D no pré-natal e/ou no pós-parto e foram avaliadas no pós-parto. As bases de dados consultadas foram PubMed, EMBASE, Cochrane e LILACS, até julho de 2019. Foram avaliados concentração sérica da vitamina D (25-hidroxivitamina D em nmol/L), glicemia de jejum, hemoglobina glicada, concentração sérica de cálcio, modelo de avaliação da homeostase de resistência à insulina (HOMA-IR, na sigla em inglês), índice qualitativo de verificação da sensibilidade à insulina (QUICKI, na sigla em inglês), hormônio da paratireoide (PTH) e índice de massa corpórea (IMC). Resultados semelhantes em pelo menos dois ensaios foram plotados no software RevMan 5; Cochrane Collaboration, Oxford, Reino Unido. A qualidade das evidências foi gerada de acordo com a classificação, o desenvolvimento e a avaliação da classificação das recomendações. Resultados Quatro estudos foram incluídos na presente revisão (200 mulheres). Os achados indicam que não há diferença no período pós-parto em mulheres com diagnóstico prévio de DMG que receberam suplementação de vitamina D no período pré-natal e/ou pós-parto, mostrando apenas que houve um aumento significativo na concentração de vitamina D (risco relativo [RR]: 1,85; IC [intervalo de confiança] 95%: 1,02-2,68). Conclusão Este aumento na concentração de vitamina D deve ser interpretado com cautela, uma vez que a avaliação da qualidade das evidências foi muito baixa. Para os demais desfechos analisados, não houve significância entre os grupos intervenção e controle, e os desfechos, quando analisados em sua força da evidência, foram considerados muito baixa e baixa em sua avaliação. PROSPERO CRD42018110729

Made available in DSpace on 2021-06-25T10:46:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-12-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) The aim was to assess the role of Metabolic Syndrome (MetS) diagnostic markers, recommended by three different guidelines, in the prediction of hyperglycemia in pregnancy. This cross-sectional cohort study included 506 non-diabetic women, with a singleton pregnancy, who underwent a diagnostic test for hyperglycemia at 24–28 weeks. Clinical, anthropometric, and laboratory data were obtained. The relationship between MetS markers and the risk of hyperglycemia was evaluated by backward stepwise logistic regression analysis (OR, 95% CI). The limit of statistical significance was 95% (p < 0.05). Triglycerides (TG) ≥ 150 mg/dL, blood pressure (BP) ≥ 130/85 mmHg, fasting glucose (FG) ≥ 100 mg/dL, and waist circumference (WC) > 88 cm were identified as independent risk factors for hyperglycemia in pregnancy. These results might help the selective screening of hyperglycemia in pregnancy. Graduate Program in Obstetrics Gynecology and Mastology Botucatu Medical School São Paulo State University/Unesp Department of Gynecology and Obstetrics Botucatu Medical School São Paulo State University/Unesp Department of Biostatistics Botucatu Institute of Biosciences São Paulo State University/Unesp Department of Nursing Botucatu Medical School São Paulo State University/Unesp Graduate Program in Obstetrics Gynecology and Mastology Botucatu Medical School São Paulo State University/Unesp Department of Gynecology and Obstetrics Botucatu Medical School São Paulo State University/Unesp Department of Biostatistics Botucatu Institute of Biosciences São Paulo State University/Unesp Department of Nursing Botucatu Medical School São Paulo State University/Unesp FAPESP: 12/51257-9 CNPq: PQ-CNPq #304771/2015-5

Objective: to identify and compare factors associated with profile, intentions, motivations, and barriers to entrepreneurial behavior of nursing students from Brazil and Chile. Methods: this cross-sectional study was carried out between March and September 2018 including 889 nursing students. A form was used to assess the socio-demographic profile, professional claims, entrepreneurial intentions and motivations. Statistical analysis used Chi-Square and Fisher’s Exact tests, with a 5% significance level, and a simple logistic regression model. Results: there are significant differences between countries in the profile of students and in the motivations studied, but not in professional pretensions and entrepreneurial intentions. Lack of education on the subject reveals itself as an important barrier to entrepreneurship. Conclusion: given the lack of teaching entrepreneurship in undergraduate nursing courses and the characteristics inherent to students, education must be appropriate to different cultures to prepare future professionals for other areas of practice. RESUMEN Objetivo: identificar y comparar los factores asociados con el perfil, intenciones, motivaciones y barreras al comportamiento emprendedor de estudiantes de enfermería de Brasil y Chile. Métodos: estudio transversal, realizado entre marzo y septiembre de 2018, que incluyó a 889 estudiantes de enfermería. Se utilizó un formulario para evaluar el perfil sociodemográfico, los reclamos profesionales, las intenciones y motivaciones empresariales. En el análisis estadístico, se utilizaron las pruebas exactas de Chi-Cuadrado y de Fisher, con un nivel de significancia de 5% y un modelo de regresión logística simple. Resultados: existen diferencias significativas entre países en el perfil de los estudiantes y en las motivaciones estudiadas, pero no en intenciones profesionales e intenciones empresariales. La falta de educación sobre el tema demuestra ser una barrera importante para el emprendimiento. Conclusión: dada la falta de enseñanza del emprendimiento en los cursos de pregrado en enfermería y las características inherentes a los estudiantes en esta área, la educación debe ser apropiada para diferentes culturas para preparar a los futuros profesionales para otras áreas de especialización. RESUMO Objetivo: identificar e comparar os fatores associados ao perfil, intenções, motivações e barreiras ao comportamento empreendedor de estudantes de enfermagem do Brasil e Chile. Métodos: estudo transversal, realizado entre março e setembro de 2018, incluindo 889 estudantes de enfermagem. Utilizou-se formulário para avaliação do perfil sociodemográfico, pretensões profissionais, intenções e motivações empreendedoras. Na análise estatística, foram utilizados os testes Qui-Quadrado e Exato de Fisher, com nível de significância 5%, e modelo de regressão logística simples. Resultados: há diferenças significativas entre os países no perfil dos alunos e nas motivações estudadas, mas não nas pretensões profissionais e intenções empreendedoras. Falta de ensino sobre o tema revela-se como importante barreira ao empreendedorismo. Conclusão: diante da carência no ensino de empreendedorismo nos cursos de graduação em enfermagem e das características inerentes aos estudantes dessa área, o ensino deve estar adequado às diferentes culturas para preparar os futuros profissionais para outras áreas de atuação.

Made available in DSpace on 2020-12-10T20:09:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-05-14 Oswaldo Cruz German Hospital Brazilian Health Ministry through the Program of Support for the Institutional Development of the Unified Health System (PROADI-SUS), 2017 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) We proposed to compare the accuracy and effectiveness of digital breast tomosynthesis (DBT), plus digital or synthetic mammography, with digital mammography alone in women attending population-based breast cancer screenings. We performed a systematic review and included controlled studies comparing DBT with digital mammography for breast cancer screening. Search strategies were applied to the MEDLINE, Embase, LILACS, and CENTRAL databases. With moderate quality of evidence, in 1,000 screens, DBT plus digital mammography increased the overall and invasive breast cancer rates by 3 and 2 (RR 1.36, 95% CI 1.18 to 1.58 and RR 1.51, 95% CI 1.27 to 1.79, respectively). DBT plus synthetic mammography increased both overall and invasive breast cancer rates by 2 (RR 1.38, 95% CI 1.24 to 1.54 and RR 1.37, 95% CI 1.22 to 1.55, respectively). DBT did not improve recall, false positive and false negative rates. However due to heterogeneity the quality of evidence was low. For women attending population-based breast cancer screenings, DBT increases rates of overall and invasive breast cancer. There is no evidence with high or moderate quality showing that DBT compared with digital mammography decreases recall rates, as well as false positive and false negative rates. Sao Paulo State Univ, UNESP, Med Sch, Dept Internal Med, Botucatu, SP, Brazil Sao Paulo State Univ, UNESP, Med Sch, Dept Nursing, Botucatu, SP, Brazil Botucatu Med Sch Clin Hosp, Hlth Technol Assessment Nucleus, Sao Paulo, Brazil Sao Paulo State Univ, Med Sch, UNESP, Ophthalmol Otorhinolaryngol & Head & Neck Surg De, Botucatu, SP, Brazil Sao Paulo State Univ, UNESP, Med Sch, Dept Internal Med, Botucatu, SP, Brazil Sao Paulo State Univ, UNESP, Med Sch, Dept Nursing, Botucatu, SP, Brazil Sao Paulo State Univ, Med Sch, UNESP, Ophthalmol Otorhinolaryngol & Head & Neck Surg De, Botucatu, SP, Brazil Brazilian Health Ministry through the Program of Support for the Institutional Development of the Unified Health System (PROADI-SUS), 2017: 25000.014916/2015-62

CONTEXT AND OBJECTIVE: This systematic review compared reiki and prayer with drug use for relieving pain during hospitalization for cesarean, given that the popularity of integrative medicine and spiritual healing has been increasing. It had the aim of evaluating whether reiki or prayer is effective in relieving pain during cesarean section. DESIGN AND SETTING: Systematic review with meta-analysis conducted at Botucatu Medical School, UNESP, São Paulo, Brazil. METHODS: The following databases were searched up to March 2016: MEDLINE, Embase, LILACS and CENTRAL. Randomized controlled trials published in English or Portuguese were included in the review. Two reviewers independently screened eligible articles, extracted data and assessed the risk of bias. A GRADE table was produced to evaluate the risk of bias. RESULTS: There was evidence with a high risk of bias showing a statistically significant decrease in pain score through use of reiki and prayer, in relation to the protocol group: mean difference = -1.68; 95% confidence interval: -1.92 to -1.43; P < 0.00001; I2 = 92%. Furthermore, there was no statistically significant difference in heart rate or systolic or diastolic blood pressure. CONCLUSION: Evidence with a high risk of bias suggested that reiki and prayer meditation might be associated with pain reduction. RESUMO CONTEXTO E OBJETIVO: Esta revisão sistemática comparou o reiki e a oração ao uso de medicamentos, a fim de aliviar a dor durante a internação para cesariana, visto que há um aumento na popularidade da medicina integrativa e cura espiritual. Esta revisão teve como objetivo avaliar se o reiki ou oração são eficazes no alívio da dor durante a cesariana. TIPO DE ESTUDO E LOCAL: Revisão sistemática com metanálise realizada na Faculdade de Medicina de Botucatu UNESP, São Paulo, Brasil. MÉTODOS: As seguintes bases de dados foram pesquisadas até março de 2016: MEDLINE, Embase, LILACS e CENTRAL. Nesse sentido, foram incluídos ensaios clínicos randomizados publicados em inglês e português. Dois revisores rastrearam independentemente artigos elegíveis, extraíram dados e avaliaram o risco de viés. A tabela GRADE foi realizada para avaliar o risco de viés. RESULTADOS: Evidências com alto índice de viés encontraram uma diminuição estatisticamente significativa na redução da dor (diferença média = -1,68; intervalo de confiança de 95%: -1,92 a -1,43; P < 0,00001; I2 = 92%), com o uso de reiki e oração comparado com o grupo protocolar. Além disso, não houve diferença estatisticamente significativa na frequência cardíaca, pressão arterial sistólica e diastólica. CONCLUSÃO: Evidência com alto risco de viés sugeriu que reiki e meditação oração podem ser associadas com a redução da dor.

BackgroundTrials have examined on the benefits of vitamin D supplementation in pregnant women.ObjectiveThis review aimed to evaluate whether oral vitamin D supplements, when given to pregnant women with gestational diabetes mellitus (GDM), would improve maternal and neonatal outcomes, compared with no treatment or placebo.MethodWe performed a systematic review following Cochrane methodology, and randomized trials were included where pregnant women with GDM received vitamin D supplementation versus placebo/no treatment or vitamin D and calcium versus placebo/no treatment. Primary outcomes were preeclampsia, preterm birth, cesarean delivery, gestational hypertension, and adverse events related to vitamin D supplementation. The search strategies were applied to the following databases: MEDLINE, Embase, LILACS, and CENTRAL. Similar outcomes in at least two trials were plotted using Review Manager 5.3 software. The quality of evidence was generated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).ResultsThe total of 1224 references were identified, eleven trials were potentially eligible, and six were included in this review (totaling 456 women). The meta-analysis of frequency of cesarean deliveries did not show significant differences between groups, none of the trials evaluated the remaining primary outcomes. For secondary outcomes, our results suggest that vitamin D supplementation in pregnant women with GDM may reduce newborn complications such as hyperbilirubinemia, polyhydramnios (RR: 0.40, 95% CI: 0.23 to 0.68; RR: 0.17, 95% CI: 0.03 to 0.89; respectively), and the need for maternal or infant hospitalization (RR: 0.13; 95% CI: 0.02 to 0.98; RR: 0.40, 95% CI: 0.23 to 0.69). However, the evidence was of low or very low quality.ConclusionWe did not find moderate or high quality evidence indicating that vitamin D supplementation, when compared with placebo, improves glucose metabolism, adverse maternal and neonatal outcomes related to GDM in pregnant women.

Made available in DSpace on 2018-12-11T17:21:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-07-01 Antenatal stress is linked to fetal risks that increase the chances of neonatal complications and reduction of child cognitive ability. Therefore, we aimed to evaluate if maternal stress affects fetal, neonatal or child development. The following databases were searched: MED-LINE (1966 to May 2016), Embase (1980 to May 2016), LILACS (1982 to May 2016) and CENTRAL (1972 to May 2016). Observational studies published in English and Portuguese were included whether there was any relationship between fetal and neonatal outcome, such as birth weight, preterm labor, child development with pregnant women that were subjected to any stress type during at least one month of follow-up. Two independent reviewers screened eligible articles, extracted data and assessed the risk of bias. Thus, 8 cohort studies with about 8,271 pregnant women and 1,081,151 children proved eligible. Results suggested a significant association between antenatal stress exposure and increasing rates of low birth weight (Odds ratio (OR) 1.68 [95% Confidential Interval (CI) 1.19, 2.38]). However, there was no statistically significance difference between non-exposed and exposed groups related to preterm labor (OR 1.98 [95% CI 0.91 to 4.31]; I2 = 68%, p = 0.04). Although, results were inconsistent with primary analysis suggesting a significant association between antenatal stress exposure and the occurrence of higher rates of preterm birth (OR 1.42 [95% CI 1.05 to 1.91]; I2 = 68%, p = 0.04) in the sensitivity analysis. Furthermore, the current review has suggested that stress perceived during antenatal negatively influences fetal life and child development. Yet, further studies are necessary with adequate sample size and longer follow-up time to confirm our findings. Nursing Department Botucatu Medical School UNESP–Univ Estadual Paulista Institute of Science and Technology Department of Biosciences and Oral Diagnosis UNESP Nursing Department of Gynecology and Obstetrics Universidade Estadual Paulista (Unesp) Botucatu Medical School UNESP Municipal Authority of Botucatu Minas Gerais Medical School UFMG -Univ Federal de Minas Gerais Department of Collective Health Botucatu Medical School Nursing Department Botucatu Medical School UNESP–Univ Estadual Paulista Institute of Science and Technology Department of Biosciences and Oral Diagnosis UNESP Nursing Department of Gynecology and Obstetrics Universidade Estadual Paulista (Unesp) Botucatu Medical School UNESP Department of Collective Health Botucatu Medical School

Background: Enteral nutrition therapy can be provided using comercialized products (chemically defined formulas) or blenderized home-made preparations. Objective: To perform an integrative review of the literature comparing the use of both type of formulation. Methods: In this descriptive study papers published in English, Spanish or Portuguese Brazil, in journals indexed in the databases PubMed, EMBASE, Scopus, Web of Science and Bireme without the period 2010 to 2015 were reviewed The terms “enteral nutrition, foods, formulated, diet, homemade diet industrial and artisanal diet” according to the MeSH were used for the search. Results: Twelve articles were selected. Most studies showed a level 4 of evidence and were published in journal in the higher Qualis index. Four aspects were evaluated: comparison between groups studying the clinical effects; comparison of the chemical composition of home-made products; physical-chemical and microbiological analysis of the enteral diets comes; articles on epidemiological Data on home enteral nutrition. Conclusion: Industrialized diet is more suitable for patients using alternative feeding supply at home. But it has a higher cost.

Background: Hysterectomy for benign gynecologic diseases, especially dysfunctional uterine bleeding, is one of the most common gynecologic interventions. The uterus can be removed using abdominal, vaginal, laparoscopic, or robotic-assisted laparoscopic hysterectomy. In a robotic-assisted procedure, the surgeon directs the robot while seated at a console in the operating room. This differs from laparoscopic hysterectomy because a “robot” performs the operation, while the surgeon watches a monitor. This systematic review will compare quality of life (QOL) in patients who undergo total robotic-assisted laparoscopic hysterectomy for benign indications and those who undergo conventional laparoscopic surgery. Methods: We will perform a systematic review according to the Cochrane Methodology for randomized controlled trials. The review will include studies reporting use of QOL metrics to assess patients who undergo total hysterectomy for benign indications using robotic-assisted technique or conventional laparoscopic surgery. QOL will be the primary outcome and will be measured using validated instruments. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases. Two reviewers will independently select the eligible studies, assess the risk of bias, and extract the data from included studies. Similar outcomes measured in at least 2 trials will be plotted in the meta-analysis using Review Manager 5.3. The quality of evidence will be determined using the GRADE approach. Results: This systematic review is designed to provide high quality evidence on QOL in patients undergoing total hysterectomy for benign indications using either robotic-assisted or conventional laparoscopic surgery. Conclusion: It is expected that high-quality evidence on QOL can be used to guide decision-making by institutions and clinicians to improve health care; the evidence can also be used in future studies. PROSPERO registration number: PROSPERO CRD 42019129913

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:05:57Z No. of bitstreams: 1 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) Made available in DSpace on 2013-08-22T19:05:57Z (GMT). No. of bitstreams: 1 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) Previous issue date: 2012-01-01 Made available in DSpace on 2013-09-30T20:09:58Z (GMT). No. of bitstreams: 2 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) S1516-31802012000100004.pdf.txt: 48569 bytes, checksum: 8b37e8a01344cf5d7ace0fd179e97fc4 (MD5) Previous issue date: 2012-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:12Z No. of bitstreams: 2 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) S1516-31802012000100004.pdf.txt: 48569 bytes, checksum: 8b37e8a01344cf5d7ace0fd179e97fc4 (MD5) Made available in DSpace on 2014-05-20T13:35:12Z (GMT). No. of bitstreams: 2 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) S1516-31802012000100004.pdf.txt: 48569 bytes, checksum: 8b37e8a01344cf5d7ace0fd179e97fc4 (MD5) Previous issue date: 2012-01-01 CONTEXTO E OBJETIVO: Gestações complicadas pelo diabetes estão associadas com aumento de complicações maternas e neonatais. Os custos hospitalares aumentam de acordo com a assistência prestada. O objetivo foi calcular o custo-benefício e a taxa de rentabilidade social da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes ou com hiperglicemia leve. DESENHO do ESTUDO: Estudo prospectivo, observacional, quantitativo, realizado em hospital universitário, sendo incluídas todas as gestantes com diabetes pregestacional e gestacional ou com hiperglicemia leve que não desenvolveram intercorrências clínicas na gestação e que tiveram parto no Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (HC-FMB-Unesp). MÉTODOS: Trinta gestantes tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta e insulina foram abordadas com hospitalizações curtas e frequentes. Foram obtidos custos diretos (pessoal, material e exames) e indiretos (despesas gerais) a partir de dados contidos no prontuário e no sistema de custo por absorção do hospital e posteriormente calculado o custo-benefício. RESULTADOS: O sucesso do tratamento das gestantes diabéticas evitou o gasto de US$ 1.517,97 e US$ 1.127,43 para pacientes hospitalizadas e ambulatoriais, respectivamente. O custo-benefício da atenção hospitalizada foi US$ 143.719,16 e ambulatorial, US$ 253.267,22, com rentabilidade social 1,87 e 5,35 respectivamente. CONCLUSÃO: A análise árvore de decisão confirma que o sucesso dos tratamentos elimina custos no hospital. A relação custo-benefício indicou que o tratamento ambulatorial é economicamente mais vantajoso do que a hospitalização. A rentabilidade social de ambos os tratamentos foi maior que 1, indicando que ambos os tipos de atendimento à gestante diabética têm benefício positivo. CONTEXT and OBJECTIVE: Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. STUDY DESIGN: This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp). METHODS: Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. RESULTS: Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. CONCLUSION: Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits. Univ Estadual Paulista Unesp, FMB, HC, Dept Gynecol & Obstet, Botucatu, SP, Brazil Univ Estadual Paulista Unesp, FMB, HC, Dept Nursing, Botucatu, SP, Brazil Univ Estadual Paulista Unesp, Postgrad Programs, Botucatu, SP, Brazil Univ Estadual Paulista Unesp, FMB, HC, Dept Gynecol & Obstet, Botucatu, SP, Brazil

A number of physical and psychological changes that occur during pregnancy can stimulate the development of psychological disorders such as anxiety and depression. The study evaluated psychological aspects related to maternal depression and anxiety in pregnant women with diabetes mellitus or hyperglycemia, contrasting the results with those of non-diabetic pregnant women.In a prospective and longitudinal approach, two questionnaires were applied and validated for use in Brazil, the Beck depression inventory and the State-Trait Anxiety Inventory. The questionnaires were applied to pregnant women at the first prenatal visit or at the time of disease diagnosis (T1) and reapplied at admission for delivery (T2). Regardless of the degree of hyperglycemia, both at first and in the second stage most women had severe anxiety trait. In early pregnancy (T1), however, severe state anxiety was more frequent in women with hyperglycemia than in those from the NG group.Most pregnant women showed moderate state anxiety over their pregnancy, regardless of glycemic status. In early pregnancy, however, severe state anxiety was more prevalent in hyperglycemic women than in those with normal glycemic status. Most women showed moderate trait anxiety and mild depression in both early and late pregnancy, irrespective of glycemic status.The incidence of severe state anxiety in early pregnancy is more frequent in women with diabetes or hyperglycemia, but their levels of trait anxiety and depression are not affected by glycemic status.

Made available in DSpace on 2014-10-01T13:08:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2013Bitstream added on 2014-10-01T14:03:04Z : No. of bitstreams: 1 S1516-31802013000500331.pdf: 647185 bytes, checksum: 8e3cf2a42effc17209ca46e08768c633 (MD5) CONTEXTO E OBJETIVO:Gestações complicadas pelo diabetes estão associadas com aumento das complicações neonatais e maternas. A complicação mais grave materna é o risco de desenvolver diabetes tipo 2 após 10-12 anos do parto. Para o controle rigoroso da glicose no sangue, as mulheres grávidas são tratadas de forma ambulatorial ou com internações hospitalares. O objetivo deste estudo é avaliar a efetividade do tratamento ambulatorial versus hospitalização em gestações complicadas por diabetes ou hiperglicemia.TIPO DE ESTUDO E LOCAL:Revisão sistemática conduzida em hospital universitário público.MÉTODOS:Uma revisão sistemática da literatura foi realizada e as principais bases de dados eletrônicas foram pesquisadas. A data da pesquisa mais recente foi 4 de setembro de 2011. Dois autores selecionaram independentemente os ensaios clínicos relevantes, avaliaram a qualidade metodológica e extraíram os dados.RESULTADOS:Apenas três estudos foram selecionados, com tamanho de amostra pequeno. Não houve diferença estatisticamente significativa entre o tratamento ambulatorial versus hospitalização em relação à mortalidade em nenhuma das subcategorias analisadas: mortes perinatais e neonatais, (risco relativo [RR] 0,65; 95% de intervalo de confiança [IC] 0,11-3,84, P = 0,63); morte neonatal (RR 0,29, IC 95% 0,01-6,07, P = 0,43), e óbitos infantis (RR 0,29, IC 95% 0,01-6,07, P = 0,43).CONCLUSÕES:Com base em estudos com risco de viés alto ou moderado, esta revisão demonstrou que não há diferença estatisticamente significante entre o tratamento ambulatorial comparado com o hospitalar na redução das taxas de mortalidade em gestações complicadas por diabetes ou hiperglicemia. Esta revisão sistemática também sugere a necessidade de mais ensaios clínicos randomizados sobre o assunto. CONTEXT AND OBJECTIVE:Pregnancies complicated by diabetes are associated with increased neonatal and maternal complications. The most serious maternal complication is the risk of developing type 2 diabetes, 10-12 years after the delivery. For rigorous control over blood glucose, pregnant women are treated through ambulatory management or hospitalization. The aim of this study was to evaluate the effectiveness of ambulatory management versus hospitalization in pregnancies complicated by diabetes or hyperglycemia.DESIGN AND SETTING:Systematic review conducted in a public university hospital.METHODS:A systematic review of the literature was performed and the main electronic databases were searched. The date of the most recent search was September 4, 2011. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data.RESULTS:Only three studies were selected, with small sample sizes. There was no statistically significance different between ambulatory management and hospitalization, regarding mortality in any of the subcategories analyzed: perinatal and neonatal deaths (relative risk [RR] 0.65; 95% confidential interval [CI]: 0.11 to 3.84; P = 0.63); neonatal deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43); and infant deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43).CONCLUSIONS:This review, based on studies with high or moderate risk of bias, showed that there was no statistically significant difference between ambulatory management and hospital care, regarding reduction of mortality rates in pregnancies complicated by diabetes or hyperglycemia. It also suggested that there is a need for further randomized controlled trials on this issue. Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Gynecology and Obstetrics Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Nursing Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Anaesthesiology Institute of Urology Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Gynecology and Obstetrics Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Nursing Universidade Estadual Paulista Faculdade de Medicina de Botucatu Department of Anaesthesiology

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:28Z No. of bitstreams: 1 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) Made available in DSpace on 2013-08-22T19:03:28Z (GMT). No. of bitstreams: 1 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) Previous issue date: 2012-04-01 Made available in DSpace on 2013-09-30T18:21:05Z (GMT). No. of bitstreams: 2 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) S0034-89102012000200016.pdf.txt: 35938 bytes, checksum: 14c12bbfb6c7e4402af90562c4773ef2 (MD5) Previous issue date: 2012-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:13Z No. of bitstreams: 2 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) S0034-89102012000200016.pdf.txt: 35938 bytes, checksum: 14c12bbfb6c7e4402af90562c4773ef2 (MD5) Made available in DSpace on 2014-05-20T13:33:13Z (GMT). No. of bitstreams: 2 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) S0034-89102012000200016.pdf.txt: 35938 bytes, checksum: 14c12bbfb6c7e4402af90562c4773ef2 (MD5) Previous issue date: 2012-04-01 OBJETIVO: Comparar custos de hospitalização e de atenção ambulatorial em gestantes/parturientes diabéticas e com hiperglicemia leve. MÉTODOS: Estudo observacional, prospectivo, quantitativo descritivo realizado em centro de diabete perinatal em Botucatu, SP, entre 2007 e 2008. Foram estimados os custos por absorção diretos e indiretos disponíveis na instituição e os custos específicos para a doença (medicamentos e exames). As 30 gestantes diabéticas tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta mais insulina foram hospitalizadas. RESULTADOS: O custo da doença diabete (para a assistência pré-natal e parto) foi de US$ 3,311.84 para as gestantes hospitalizadas e de US$ 1,366.04 para as acompanhadas em ambulatório. CONCLUSÕES: Os custos diretos e indiretos e o custo total da assistência pré-natal foram mais elevados nas gestantes diabéticas hospitalizadas enquanto os custos da assistência ao parto e hospitalização para parto e puerpério foram semelhantes. Os custos da assistência pré-natal como no parto/puerpério foram superiores aos valores pagos pelo Sistema Único de Saúde. OBJECTIVE: To compare inpatient and outpatient care costs for pregnant/parturient women with diabetes and mild hyperglycemia. METHODS: A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and 2008. Direct and indirect costs and disease-specific costs (medications and tests) were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS: The cost of diabetes disease (prenatal and delivery care) was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS: Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and delivery-postpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System. OBJETIVO: Comparar costos de hospitalización y de atención por ambulatorio en gestantes/parturientas diabéticas y con hiperglicemia leve. MÉTODOS: Estudio observacional, prospectivo, cuantitativo descriptivo realizado en centro de diabetes perinatal en Botucatu, Sureste de Brasil, entre 2007 y 2008. Se estimaron los costos por absorción directos e indirectos disponibles en la institución y los costos específicos para la enfermedad (medicamentos y exámenes). Las 30 gestantes diabéticas tratadas con dieta fueron acompañadas en ambulatorio y 20 tratadas con dieta más insulina fueron hospitalizadas. RESULTADOS: El costo de la enfermedad diabetes (para asistencia prenatal y parto) fue de US$ 3,311.84 para las gestantes hospitalizadas y de US$ 1,366.04 para las acompañadas en ambulatorio. CONCLUSIONES: Los costos directos e indirectos y el costo total de la asistencia prenatal fueron más elevados en las gestantes diabéticas hospitalizadas mientras que los costos de la asistencia al parto y hospitalización para parto y puerperio fueron semejantes. Los costos de la asistencia prenatal como en el parto/puerperio fueron superiores a los valores pagados por el Sistema Único de Salud. Univ Estadual Paulista Julio de Mesquita Filho Un, Grad Program Gynecol Obstet & Mastol, Botucatu Med Sch, Botucatu, SP, Brazil UNESP, Botucatu Med Sch, Dept Nursing, Botucatu, SP, Brazil Unesp Botucatu Medical School Department of Obstetrics and Gynecology Univ Estadual Paulista Julio de Mesquita Filho Un, Grad Program Gynecol Obstet & Mastol, Botucatu Med Sch, Botucatu, SP, Brazil UNESP, Botucatu Med Sch, Dept Nursing, Botucatu, SP, Brazil Unesp Botucatu Medical School Department of Obstetrics and Gynecology

Made available in DSpace on 2020-12-11T05:11:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-12-01. Added 1 bitstream(s) on 2021-07-15T14:37:31Z : No. of bitstreams: 1 S0034-71672019000900305.pdf: 526873 bytes, checksum: 42e7dc60ad767a75efc561f140129292 (MD5) Objective: to understand the satisfaction of pregnant women with diabetes who took insulin during pregnancy and prenatal care performed through outpatient and inpatient follow-up. Method: a qualitative approach with analysis of 30 pregnant women who underwent prenatal care and participated in a clinical trial study carried out by the research group of the Perinatal Diabetes Research Center of the Hospital das Clinicas, of the Faculdade de Medidna de Botucatu. The data were collected through interviews and analyzed from content analysis. Results: from the category Satisfaction, the following subcategories emerged: facilities and difficulties faced in prenatal care performed through outpatient or inpatient follow-up, demonstrating that the pregnant women were satisfied with the prenatal care offered regardless of the type of followup. Conclusion: there was satisfaction in both care, but in outpatient care some structural, technical and administrative difficulties were identified, requiring reassessment, in order to guarantee service agility. Univ Estadual Paulista, Botucatu, SP, Brazil Univ Estadual Paulista, Botucatu, SP, Brazil