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[PMID]:29248014
[Au] Autor:Peltzer K; Weiss SM; Soni M; Lee TK; Rodriguez VJ; Cook R; Alcaide ML; Setswe G; Jones DL
[Ad] Endereço:HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa. kpeltzer@hsrc.ac.za.
[Ti] Título:A cluster randomized controlled trial of lay health worker support for prevention of mother to child transmission of HIV (PMTCT) in South Africa.
[So] Source:AIDS Res Ther;14(1):61, 2017 Dec 16.
[Is] ISSN:1742-6405
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We evaluate the impact of clinic-based PMTCT community support by trained lay health workers in addition to standard clinical care on PMTCT infant outcomes. METHODS: In a cluster randomized controlled trial, twelve community health centers (CHCs) in Mpumalanga Province, South Africa, were randomized to have pregnant women living with HIV receive either: a standard care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n  = 357), or an enhanced intervention (EI) condition of SC PMTCT plus the "Protect Your Family" intervention (EI; 6 CHCs; n  = 342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions and those in the EI, four antenatal and two postnatal PMTCT plus "Protect Your Family" sessions led by trained lay health workers. Maternal PMTCT and HIV knowledge were assessed. Infant HIV status at 6 weeks postnatal was drawn from clinic PCR records; at 12 months, HIV status was assessed by study administered DNA PCR. Maternal adherence was assessed by dried blood spot at 32 weeks, and infant adherence was assessed by maternal report at 6 weeks. The impact of the EI was ascertained on primary outcomes (infant HIV status at 6 weeks and 12 months and ART adherence for mothers and infants), and secondary outcomes (HIV and PMTCT knowledge and HIV transmission related behaviours). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention on study outcomes. RESULTS: In all, 699 women living with HIV were recruited during pregnancy (8-24 weeks), and assessments were completed at baseline, at 32 weeks pregnant (61.7%), and at 6 weeks (47.6%), 6 months (50.6%) and 12 months (59.5%) postnatally. Infants were tested for HIV at 6 weeks and 12 months, 73.5% living infants were tested at 6 weeks and 56.7% at 12 months. There were no significant differences between SC and EI on infant HIV status at 6 weeks and at 12 months, and no differences in maternal adherence at 32 weeks, reported infant adherence at 6 weeks, or PMTCT and HIV knowledge by study condition over time. CONCLUSION: The enhanced intervention administered by trained lay health workers did not have any salutary impact on HIV infant status, ART adherence, HIV and PMTCT knowledge. Trial registration clinicaltrials.gov: number NCT02085356.
[Mh] Termos MeSH primário: Infecções por HIV/prevenção & controle
Infecções por HIV/transmissão
Transmissão Vertical de Doença Infecciosa/prevenção & controle
Cuidado Pós-Natal/métodos
Cuidado Pré-Natal/métodos
[Mh] Termos MeSH secundário: Fármacos Anti-HIV/uso terapêutico
Feminino
Infecções por HIV/tratamento farmacológico
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Lactente
Recém-Nascido
Mães
Educação de Pacientes como Assunto
Gravidez
Complicações Infecciosas na Gravidez/tratamento farmacológico
Apoio Social
África do Sul
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:171218
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1186/s12981-017-0187-2


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[PMID]:29271473
[Au] Autor:Woodley SJ; Boyle R; Cody JD; Mørkved S; Hay-Smith EJC
[Ad] Endereço:Department of Anatomy, University of Otago, Lindo Ferguson Building, 270 Great King Street, Dunedin, Otago, New Zealand, 9054.
[Ti] Título:Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women.
[So] Source:Cochrane Database Syst Rev;12:CD007471, 2017 12 22.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: About one-third of women have urinary incontinence and up to one-tenth have faecal incontinence after childbirth. Pelvic floor muscle training (PFMT) is commonly recommended during pregnancy and after birth for both prevention and treatment of incontinence.This is an update of a review previously published in 2012. OBJECTIVES: To determine the effectiveness of pelvic floor muscle training (PFMT) in the prevention or treatment of urinary and faecal incontinence in pregnant or postnatal women. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register (16 February 2017) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised or quasi-randomised trials in pregnant or postnatal women. One arm of the trial included PFMT. Another arm was no PFMT, usual antenatal or postnatal care, another control condition, or an alternative PFMT intervention. DATA COLLECTION AND ANALYSIS: Review authors independently assessed trials for inclusion and risk of bias. We extracted data and checked them for accuracy. Populations included: women who were continent (PFMT for prevention), women who were incontinent (PFMT for treatment) at randomisation and a mixed population of women who were one or the other (PFMT for prevention or treatment). We assessed quality of evidence using the GRADE approach. MAIN RESULTS: The review included 38 trials (17 of which were new for this update) involving 9892 women from 20 countries. Overall, trials were small to moderate sized, and the PFMT programmes and control conditions varied considerably and were often poorly described. Many trials were at moderate to high risk of bias. Other than two reports of pelvic floor pain, trials reported no harmful effects of PFMT.Prevention of urinary incontinence: compared with usual care, continent pregnant women performing antenatal PFMT may have had a lower risk of reporting urinary incontinence in late pregnancy (62% less; risk ratio (RR) for incontinence 0.38, 95% confidence interval (CI) 0.20 to 0.72; 6 trials, 624 women; low-quality evidence). Similarly, antenatal PFMT decreased the risk of urinary incontinence in the mid-postnatal period (more than three to six months' postpartum) (29% less; RR 0.71, 95% CI 0.54 to 0.95; 5 trials, 673 women; moderate-quality evidence). There was insufficient information available for the late (more than six to 12 months') postnatal period to determine effects at this time point.Treatment of urinary incontinence: it is uncertain whether antenatal PFMT in incontinent women decreases incontinence in late pregnancy compared to usual care (RR 0.70, 95% CI 0.44 to 1.13; 3 trials, 345 women; very low-quality evidence). This uncertainty extends into the mid- (RR 0.94, 95% CI 0.70 to 1.24; 1 trial, 187 women; very low-quality evidence) and late (RR 0.50, 95% CI 0.13 to 1.93; 2 trials, 869 women; very low-quality evidence) postnatal periods. In postnatal women with persistent urinary incontinence, it was unclear whether PFMT reduced urinary incontinence at more than six to 12 months' postpartum (RR 0.55, 95% CI 0.29 to 1.07; 3 trials; 696 women; very low-quality evidence).Mixed prevention and treatment approach to urinary incontinence: antenatal PFMT in women with or without urinary incontinence (mixed population) may decrease urinary incontinence risk in late pregnancy (26% less; RR 0.74, 95% CI 0.61 to 0.90; 9 trials, 3164 women; low-quality evidence) and the mid-postnatal period (RR 0.73, 95% CI 0.55 to 0.97; 5 trials, 1921 women; very low-quality evidence). It is uncertain if antenatal PFMT reduces urinary incontinence risk late postpartum (RR 0.85, 95% CI 0.63 to 1.14; 2 trials, 244 women; low-quality evidence). For PFMT begun after delivery, there was considerable uncertainty about the effect on urinary incontinence risk in the late postnatal period (RR 0.88, 95% CI 0.71 to 1.09; 3 trials, 826 women; very low-quality evidence).Faecal incontinence: six trials reported faecal incontinence outcomes. In postnatal women with persistent faecal incontinence, it was uncertain whether PFMT reduced incontinence in the late postnatal period compared to usual care (RR 0.68, 95% CI 0.24 to 1.94; 2 trials; 620 women; very low-quality evidence). In women with or without faecal incontinence (mixed population), antenatal PFMT led to little or no difference in the prevalence of faecal incontinence in late pregnancy (RR 0.61, 95% CI 0.30 to 1.25; 2 trials, 867 women; moderate-quality evidence). For postnatal PFMT in a mixed population, there was considerable uncertainty about the effect on faecal incontinence in the late postnatal period (RR 0.73, 95% CI 0.13 to 4.21; 1 trial, 107 women, very low-quality evidence).There was little evidence about effects on urinary or faecal incontinence beyond 12 months' postpartum. There were few incontinence-specific quality of life data and little consensus on how to measure it. We found no data on health economics outcomes. AUTHORS' CONCLUSIONS: Targeting continent antenatal women early in pregnancy and offering a structured PFMT programme may prevent the onset of urinary incontinence in late pregnancy and postpartum. However, the cost-effectiveness of this is unknown. Population approaches (recruiting antenatal women regardless of continence status) may have a smaller effect on urinary incontinence, although the reasons for this are unclear. It is uncertain whether a population-based approach for delivering postnatal PFMT is effective in reducing urinary incontinence. Uncertainty surrounds the effects of PFMT as a treatment for urinary incontinence in antenatal and postnatal women, which contrasts with the more established effectiveness in mid-life women.It is possible that the effects of PFMT might be greater with targeted rather than mixed prevention and treatment approaches and in certain groups of women. Hypothetically, for instance, women with a high body mass index are at risk factor for urinary incontinence. Such uncertainties require further testing and data on duration of effect are also needed. The physiological and behavioural aspects of exercise programmes must be described for both PFMT and control groups and how much PFMT women in both groups do, to increase understanding of what works and for whom.Few data exist on faecal incontinence or costs and it is important that both are included in any future trials. It is essential that future trials use valid measures of incontinence-specific quality of life for both urinary and faecal incontinence.
[Mh] Termos MeSH primário: Terapia por Exercício/métodos
Incontinência Fecal/terapia
Diafragma da Pelve
Complicações na Gravidez/terapia
Incontinência Urinária/terapia
[Mh] Termos MeSH secundário: Incontinência Fecal/prevenção & controle
Feminino
Seres Humanos
Cuidado Pós-Natal
Gravidez
Complicações na Gravidez/prevenção & controle
Cuidado Pré-Natal
Ensaios Clínicos Controlados Aleatórios como Assunto
Incontinência Urinária/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171223
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD007471.pub3


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[PMID]:29205275
[Au] Autor:O'Kelly SM; Moore ZE
[Ad] Endereço:General Practice (Public Health), Ranelagh Medical, 22-26 Sandford Road, Ranelagh, Dublin 6, Ireland.
[Ti] Título:Antenatal maternal education for improving postnatal perineal healing for women who have birthed in a hospital setting.
[So] Source:Cochrane Database Syst Rev;12:CD012258, 2017 12 04.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The female perineum becomes suffused and stretched during pregnancy, and further strain during vaginal childbirth contributes to approximately 85% of women experiencing some degree of trauma to the perineal region. Multiple factors play a role in the type and severity of trauma experienced, including parity, delivery method, and local practices. There is ongoing debate about best midwifery practice to reduce perineal trauma. Once perineal trauma has occurred, treatment also varies greatly, depending on its degree and severity, local practice and customs, and personal preference. In order to optimise wound-healing outcomes, it is important that wounds are assessed and managed in an appropriate and timely manner. A perineal wound may cause significant physical and/or psychological impact in the short or long term, however little evidence is available on this subject.Antenatal education serves to prepare women and their partners for pregnancy, delivery and the postpartum period. The delivery of this education varies widely in type, content, and nature. This review examined antenatal education which is specifically tailored towards perineal care and wound healing in the postnatal period via formal channels. Appropriate patient education positively impacts on wound-healing rates and compliance with wound care. Risk factors that contribute to the breakdown of wounds and poor healing rates may be addressed antenatally in order to optimise postnatal wound healing. It is important to assess whether or not antenatal wound-care education positively affects perineal healing, in order to empower women to incorporate best practice, evidence-based treatment with this important aspect of self-care in the immediate postnatal period. OBJECTIVES: To evaluate the effects of antenatal education on perineal wound healing in postnatal women who have birthed in a hospital setting, and who have experienced a break in the skin of the perineum as a result of a tear or episiotomy, or both. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2017), ClinicalTrials.gov (8th September 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (8th September 2017) and reference lists of retrieved studies. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) which referred to all formal methods of antenatal education and addressed care of a potential perineal wound as a result of a tear or episiotomy, which was experienced by pregnant women who planned to give birth within a hospital setting.Trials using a cluster-RCT and a quasi-randomised design would have been eligible for inclusion in this review but none were identified. Cross-over trials were not eligible for inclusion in this review. Studies published in abstract form would have been eligible for inclusion in this review, but none were identified.We planned to consider all formal methods of antenatal education which addressed care of a perineal wound. We also planned to consider all contact points where there was an opportunity for formal education, including midwifery appointments, antenatal education classes, obstetrician appointments, general practitioner appointments and physiotherapist appointments. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for their eligibility. MAIN RESULTS: No studies met the inclusion criteria for this review. We excluded one study and one other study is ongoing. AUTHORS' CONCLUSIONS: We set out to evaluate the RCT evidence pertaining to the impact of antenatal education on perineal wound healing in postnatal women who have birthed in a hospital setting, and who experienced a break in the skin of the perineum as a result of a tear or episiotomy, or both. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether or not antenatal education relating to perineal wound healing in this cohort of women will change the outcome for these women in relation to wound healing, infection rate, re-attendance or re-admission to hospital, pain, health-related quality of life, maternal bonding, and negative emotional experiences. Further study is warranted in this area given the significant physical, psychological and economic impact of perineal wounds, and the large proportion of childbearing women who have experienced a postnatal wound. The benefits of any future research in this field would be maximised by incorporating women in a range of socio-economic groups, and with a range of healthcare options. This research could take both a qualitative and a quantitative approach and examine the outcomes identified in this review in order to assess fully the potential benefits of a tailored antenatal package, and to make recommendations for future practice. There is currently no evidence to inform practice in this regard.
[Mh] Termos MeSH primário: Mães/educação
Períneo/lesões
Cuidado Pós-Natal
Cuidado Pré-Natal/métodos
Cicatrização
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012258.pub2


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[PMID]:28455081
[Au] Autor:Martinez NG; Niznik CM; Yee LM
[Ad] Endereço:Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
[Ti] Título:Optimizing postpartum care for the patient with gestational diabetes mellitus.
[So] Source:Am J Obstet Gynecol;217(3):314-321, 2017 09.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Gestational diabetes mellitus poses well-established risks to both the mother and infant. As >50% of women with gestational diabetes mellitus will develop type 2 diabetes mellitus in their lifetime, performing postpartum oral glucose tolerance testing is paramount to initiation of appropriate lifestyle interventions and pharmacologic therapy. Nonetheless, test completion among women with gestational diabetes mellitus is estimated to be <50%, with particularly low rates in Latina patients, as well as patients with public insurance, low education levels, and low health literacy. Data suggest our current health services infrastructure loses patients in the postpartum gap between pregnancy-focused care and primary care. Previous studies have suggested strategies to promote oral glucose tolerance testing completion to identify type 2 diabetes mellitus. Based on existing evidence, we propose best practices for the postpartum care of women with gestational diabetes mellitus: (1) enhanced patient support for identifying long-term health care providers, (2) patient-centered medical home utilization when possible, (3) patient and provider test reminders, and (4) formalized obstetrician-primary care provider hand offs using the Situation Background Assessment Recommendation (SBAR) mnemonic. These strategies deserve future investigation to solidify a multilevel approach for identifying and preventing the continuum of diabetes.
[Mh] Termos MeSH primário: Diabetes Gestacional/terapia
Cuidado Pós-Natal/organização & administração
Cuidado Transicional
[Mh] Termos MeSH secundário: Feminino
Teste de Tolerância a Glucose
Acesso aos Serviços de Saúde
Seres Humanos
Guias de Prática Clínica como Assunto
Gravidez
Atenção Primária à Saúde
Sistemas de Alerta
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29211390
[Au] Autor:Prendergast E; James J
[Ti] Título:Engaging mothers: Breastfeeding experiences recounted (EMBER). A pilot study.
[So] Source:Breastfeed Rev;24(2):11-9, 2016 Jul.
[Is] ISSN:0729-2759
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There is an abundance of published literature that describes the short- and long-term effects of breastfeeding for both the infant and mother. Despite the majority of women having good intentions to breastfeed, challenges that they encounter place their breastfeeding journey in jeopardy. Improving breastfeeding rates and durations is a significant public health priority at a local, national and international level. AIM: This pilot study aimed to identify and describe participating women's breastfeeding experiences in order to better understand why some achieve their breastfeeding goals, despite experiencing challenge and others do not. METHOD: A qualitative methodology was chosen to allow these mothers to have their voices heard. Twenty Australian Breastfeeding Association trainee counsellors, who were undertaking the Certificate IV in Breastfeeding Education, gave permission for the examination and analysis of their de-identified reflections on their own breastfeeding experiences. Data was examined and thematically analysed into identified themes. RESULTS: Participants' breastfeeding experiences were identified into six themes: 1. expectation of breastfeeding, 2. motivation to breastfeed, 3. support to maintain breastfeeding, 4. returning to work, 5. the experience of breastfeeding and 6. social attitude to public breastfeeding. The responses and experiences were varied, with each woman describing a particular event that had a significant impact on her breastfeeding journey. CONCLUSION: It is not completely understood why some mothers continue with their breastfeeding journey, whilst others discontinue earlier than they had planned. Women in this pilot study reported that support, acceptability of breastfeeding to their family and social circle, public breastfeeding, issues around infant sleep and maternal fatigue were all significant issues for them as they navigated breastfeeding for the first time.Findings from this pilot study will be used to inform the development of a larger study which will further explore women's decision making, as well as identify what supports are needed to improve women's experience of breastfeeding.
[Mh] Termos MeSH primário: Aleitamento Materno/psicologia
Relações Mãe-Filho
Mães/psicologia
Apoio Social
[Mh] Termos MeSH secundário: Adulto
Comportamento de Escolha
Feminino
Seres Humanos
Recém-Nascido
Projetos Piloto
Cuidado Pós-Natal/psicologia
Pesquisa Qualitativa
Grupos de Autoajuda
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:K
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


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[PMID]:29211384
[Au] Autor:Alianmoghaddam N; Phibbs S; Benn C
[Ti] Título:New Zealand women talk about breastfeeding support from male family members.
[So] Source:Breastfeed Rev;25(1):35-44, 2017 Mar.
[Is] ISSN:0729-2759
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:AIM: Little research has been done to investigate the influence of male family members' support for breastfeeding. This article considers the influence of male partners and other male family members on the initiation and duration of exclusive breastfeeding. METHODS: Thirty heterosexual New Zealand women who had identified in a short antenatal questionnaire that they intended to breastfeed exclusively for 6 months were recruited. The qualitative research included a face-to-face postpartum interview followed by monthly audio-recorded telephone interviews that stopped at 6 months. The participants' narratives were analysed using thematic analysis. KEY FINDINGS: Five key themes related to breastfeeding support from male family members were identified: a) male partners did not have enough knowledge about breastfeeding, b) male partners wanted to share infant feeding, c) participants received emotional and practical support from their male partners, d) male partners supported breastfeeding in public, e) some women received crucial breastfeeding support from male family members who were not the father of the baby. CONCLUSION: Comments from participants suggest that some New Zealand men are actively involved in supporting breastfeeding in their nuclear and extended families. Several participants suggested that male support was as effective as support from female family members.
[Mh] Termos MeSH primário: Aleitamento Materno/psicologia
Mães/psicologia
Período Pós-Parto/psicologia
Cônjuges/psicologia
[Mh] Termos MeSH secundário: Adulto
Relações Familiares
Feminino
Grupos Focais
Seres Humanos
Masculino
Nova Zelândia
Cuidado Pós-Natal/métodos
Apoio Social
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:K
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


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[PMID]:28924061
[Au] Autor:Meek JY
[Ad] Endereço:College of Medicine, Florida State University, Tallahassee, Florida joan.meek@med.fsu.edu.
[Ti] Título:Pediatrician Competency in Breastfeeding Support Has Room for Improvement.
[So] Source:Pediatrics;140(4), 2017 10.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Aleitamento Materno
Pediatras
[Mh] Termos MeSH secundário: Competência Clínica
Feminino
Seres Humanos
Cuidado Pós-Natal
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE


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[PMID]:28885403
[Au] Autor:Eubanks A; Petersen SM
[Ad] Endereço:Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland.
[Ti] Título:Postpartum Management After Obstetric Anal Sphincter Injuries.
[So] Source:Obstet Gynecol;130(4):870-872, 2017 Oct.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A 26-year-old woman, gravida 1 para 1, experiences a severe perineal laceration that extends through the rectal mucosa after a vaginal delivery. She asks you, "What can be done to optimize my recovery?"
[Mh] Termos MeSH primário: Canal Anal/lesões
Parto Obstétrico/efeitos adversos
Transtornos Puerperais/terapia
[Mh] Termos MeSH secundário: Adulto
Antibacterianos/administração & dosagem
Feminino
Seres Humanos
Medição da Dor
Cuidado Pós-Natal
Gravidez
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002211


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[PMID]:28770973
[Au] Autor:Yonemoto N; Dowswell T; Nagai S; Mori R
[Ad] Endereço:Department of Epidemiology and Biostatistics, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashimachi, Kodaira, Tokyo, Japan, 187-8553.
[Ti] Título:Schedules for home visits in the early postpartum period.
[So] Source:Cochrane Database Syst Rev;8:CD009326, 2017 08 02.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. OBJECTIVES: To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems). DATA COLLECTION AND ANALYSIS: Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software. MAIN RESULTS: We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no consistent evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. In a cluster randomised trial comparing usual care with individualised care by midwives extended up to three months after the birth, the proportions of women with Edinburgh postnatal depression scale (EPDS) scores ≥ 13 at four months was reduced in the individualised care group (RR 0.68, 95% CI 0.53 to 0.86). There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care. AUTHORS' CONCLUSIONS: Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women, although overall findings in different studies were not consistent. The frequency, timing, duration and intensity of such postnatal care visits should be based upon local and individual needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
[Mh] Termos MeSH primário: Visita Domiciliar
Cuidado Pós-Natal/organização & administração
[Mh] Termos MeSH secundário: Feminino
Visita Domiciliar/estatística & dados numéricos
Seres Humanos
Lactente
Mortalidade Infantil
Recém-Nascido
Mortalidade Materna
Mortalidade Perinatal
Cuidado Pós-Natal/estatística & dados numéricos
Período Pós-Parto
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009326.pub3


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[PMID]:28720035
[Au] Autor:Casey PH; Irby C; Withers S; Dorsey S; Li J; Rettiganti M
[Ad] Endereço:1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.
[Ti] Título:Home Visiting and the Health of Preterm Infants.
[So] Source:Clin Pediatr (Phila);56(9):828-837, 2017 Aug.
[Is] ISSN:1938-2707
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The results of home visiting programs which target medically fragile low-birth-weight preterm infants (LBWPT) have been inconsistent. We provided nurse/social worker home visits to families of LBWPT infants on a regular schedule. Teams were trained in approaches to improve the health and development of the infants. The completion of immunization series was sigmificantly higher and the infant mortality rates of the home visits childen were significanly lower compared to national and state rates. We used state Medicaid data and examined frequency of hospitalization, emergency department visits, routine and nonscheduled visits to primary care physician, and pharmacy use of the home-visited subjects compared with a propensity-matched group. The home-visited group had more routine and nonscheduled visits but no more hospitalizations or E.D. visits. Home visiting teams improved important markers of child health, including completed immunizations and mortality rate, perhaps by the careful monitoring of health status and assuring health care when needed.
[Mh] Termos MeSH primário: Serviços de Assistência Domiciliar/estatística & dados numéricos
Visita Domiciliar/estatística & dados numéricos
Cuidado Pós-Natal/métodos
[Mh] Termos MeSH secundário: Arkansas
Pré-Escolar
Feminino
Hospitalização/estatística & dados numéricos
Seres Humanos
Imunização/estatística & dados numéricos
Lactente
Mortalidade Infantil
Recém-Nascido de Baixo Peso
Recém-Nascido
Recém-Nascido Prematuro
Masculino
Medicaid
Atenção Primária à Saúde/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE
[do] DOI:10.1177/0009922817715949



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