Escola Paulista de Enfermagem (EPE)
URI Permanente desta comunidade
A Escola Paulista de Enfermagem (EPE) da Universidade Federal de São Paulo, situada no Campus São Paulo, é uma unidade universitária que exerce atividades de ensino, pesquisa, assistência e extensão. Durante sua história de 75 anos, a EPE – que atualmente mantém intercâmbio científico e cultural com universidades europeias – tem contribuído para o avanço da ciência da Enfermagem por meio de pesquisas inovadoras, aprendizado prático e um firme compromisso com a comunidade.
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Navegando Escola Paulista de Enfermagem (EPE) por Orientador(es) "Abrao, Ana Cristina Freitas De Vilhena [UNIFESP]"
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- ItemSomente MetadadadosAleitamento materno e alimentação complementar de crianças em um município da Amazônia Ocidental Brasileira(Universidade Federal de São Paulo (UNIFESP), 2019-03-28) Silva, Vanizia Barboza Da [UNIFESP]; Abrao, Ana Cristina Freitas De Vilhena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To assess supplementary feeding and breastfeeding of children from 0 to 23 months, born in Cruzeiro do Sul, a city located in the Brazilian Western Amazon region. Method: A cross-sectional study was carried out during national immunization campaigns in 2016 and 2017. Cluster sampling size calculation was applied in the methodology, resulting in the number of 856 children. The research tool was based on the questionnaire provided by the II Health Ministry Breastfeeding Prevalence Research, which was adapted according to the study needs. Data collection was carried out with mothers or chaperones who showed up at the basic health unit on the campaign day, or prior and after. For analyzing early weaning, Chi-square, Kolmogorov-Smirnov, and Hosmer-Lemeshow tests were used. For total weaning, Kaplan-Meier survival analysis and Cox Model were utilized. The Poisson regression model with robust variance was applied to analyze supplementary feeding. For all statistical tests, a 5% level of confidence and IBM SPSS 20.0 and Stata 12 statistical software were used. Results. The prevalence of exclusive breastfeeding was 34.7% (CI 31.1 – 38.4) and mixed breastfeeding was 65.3% (CI 62.0 – 69.2). Factors associated with early weaning were paternal education and previous breastfeeding experience. Factors associated with total breastfeeding were: length of the previous breastfeeding experience lower than 6 months, lack of breastfeeding during the first hour, and use of pacifiers and bottles. The assessment of supplementary feeding indicators identified that only 11.7% of the sample had a timely introduction to solid food, and only 9.0% had minimum food diversity, whereas 42.3% practiced the minimum frequency and adequate consistency. The consumption of food rich in iron was 85.5% and vitamin A was 58.7%. Ultra-processed foods were consumed by 98.9% of the children and the consumption of sweetened beverages was 72.7%. The main factors associated with inadequate food intake were: poor maternal and paternal education, low income, living in the countryside, age of children between 6 and 11 months, whereas income between 1 and 2 minimum wages or more was inversely associated with the outcome. Conclusions: Eating habits in children under two years of age lag behind the WHO and the HM recommendations. There is a need to improve health public policies in this area to optimize the quality of life of these children.
- ItemSomente MetadadadosAleitamento materno na primeira hora de vida e sua relação com a autoeficácia materna para amamentar(Universidade Federal de São Paulo (UNIFESP), 2019-11-28) Lucca, Marina Moraes Di [UNIFESP]; Abrao, Ana Cristina Freitas De Vilhena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To identify the prevalence of breastfeeding in the first hour of life, the levels of breastfeeding self-efficacy and the possible associations between the practice of breastfeeding in the first hour of life, breastfeeding self-efficacy levels and the variables analyzed. Method: Cross-sectional study conducted at the Amparo Maternal Joint Accommodation Unit between June 2017 and June 2018 with 360 puerperal women. To investigate maternal breastfeeding self-efficacy, we opted for the Breastfeeding Self-Efficacy Scale - Short Form (BSES-SF). To record the other variables, we used a form designed specifically for this purpose. All participants completed the Informed Consent Form. Results: The prevalence of breastfeeding in the first hour of life was 70.7% and the average breastfeeding self-efficacy score was 54.6 points, with a median of 54 points. The variable breastfeeding self-efficacy was classified into two levels: higher levels of self-efficacy (≥ 54 points) and lower levels of self-efficacy (<54 points). The variables independently associated with breastfeeding in the first hour of life were: women's perception of the amount of colostrum / milk in production (OR = 3.36; 95% CI: 1.26-9.54; p = 0.016) and previous experience in breastfeeding in the first hour of life (OR = 2.78; 95% CI: 1.32-5.88; p = 0.007). The variables independently associated with higher levels of breastfeeding self-efficacy were: guidance on breastfeeding in the first hour of life during prenatal care (OR = 2.10; 95% CI: 1.16-3.81; p = 0.014) and breastfeeding in the first hour of life (OR = 1.71; 95% CI: 1.07-2.74; p = 0.026). Conclusion: Based on the multivariate and adjusted analysis, it was concluded that breastfeeding in the first hour of life collaborated to the normal perception of women regarding the amount of colostrum / milk, as well as having previous experience in breastfeeding in the first hour of life increased the chances of this practice occurring again. It was also found that not receiving guidance on breastfeeding in the first hour of life during prenatal care, as well as not breastfeeding in the first hour of life of the newborn, contributed to higher levels of breastfeeding self-efficacy.
- ItemSomente MetadadadosAutoeficácia para a amamentação em mulheres com mamoplastia de aumento e redutora(Universidade Federal de São Paulo (UNIFESP), 2019-08-29) Eugenio, Daniella Soares [UNIFESP]; Abrao, Ana Cristina Freitas De Vilhena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Women with breast augmentation and reduction mammoplasty have a lower prevalence of exclusive breastfeeding when compared to those without surgery. Considering self-efficacy for breastfeeding one of the modifiable factors in the prevention of early weaning, it is opportune to know the behavior of this variable in this population. Objectives: To analyze the self-efficacy for breastfeeding in relation to the group of women without breast surgery and with mammoplasty. Method: A cross-sectional study was carried out in a private maternity hospital in the city of São Paulo, with 252 women, 100 of the non-surgical group, 83 of the augmentation mammoplasty group and 69 of the reduction mammoplasty group. Data collection was performed between the 5th and 7th day after delivery through the Breastfeeding Self-Efficacy Scale Short Form Brazilian Version. Results: It was verified that the average of self-efficacy scores for breastfeeding was equal between the group of women without breast surgery and that of women with augmentation mammoplasty and greater in relation to the group of women with reduction mammoplasty and this difference was statistically significant ( p = 0.010). Regarding the mean score of the self-efficacy technique for breastfeeding, this was the same among the group of women without surgery and augmentation mammoplasty and was higher in relation to the group of women with reduction mammoplasty and this difference was statistically significant (p < 0.001). The relationship between self-efficacy and the type of breastfeeding, the volume of breast milk extracted and the associated factors are independent of mammoplasty. In this perspective, it was observed that the relationship between self-efficacy and the practice of AME was statistically significant and that for every 1 point increased in the BSES-SFVB global score there was a 16% increase in the chance of AME. It was also identified that women with reduction mammoplasty are 90% less likely to breastfeed exclusively when compared to women without surgery. The relationship between self-efficacy and volume of breast milk extracted was statistically significant and for each 1 point increased in the BSES-SFVB total score there was an increase of 1.36 ml in the volume of milk extracted. It was also found that women with reductive mammoplasty presented 37.2 ml less than the volume of milked milk when compared to those without surgery. Regarding the associated factors, it was identified that vaginal delivery and the perception of adequate milk production favor higher self-efficacy scores for breastfeeding. Conclusion: Self-efficacy for breastfeeding is affected by reductive mammoplasty.
- ItemSomente MetadadadosA Mamoplastia De Aumento E A Prática Do Aleitamento Materno(Universidade Federal de São Paulo (UNIFESP), 2017-09-28) Marcacine, Karla Oliveira [UNIFESP]; Abrao, Ana Cristina Freitas De Vilhena [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Recent research shows that the number of aesthetic plastic surgeries is increasing in Brazil and worldwide and that women undergoing breast augmentation surgery tend to breastfeed for less time, compared to those without surgery. Purpose: To assess the repercussions of breast augmentation during breastfeeding in the first 30 days following delivery. Method: It consisted of a prospective cohort analysis performed at a private hospital in the city of São Paulo, SP in the period 2015-2017, with 240 women, 125 of whom had no surgery, with 115 who had undergone breast augmentation, through three evaluations – the first held between 12 and 72 hours, the second between the 5th and the 7th days, and the third between the 30th and the 32nd days after delivery. Results: The groups were homogeneous. In most women, the surgery had been performed up to 10 years prior, with inframammary incision and pre-pectoral implant placement. The mean prosthesis size was 267 ml. Almost all of the women were told that the surgery would not interfere with breastfeeding and more than half reported concern about breastfeeding. In the first evaluation, the group with breast augmentation presented lower rates of exclusive breastfeeding (EBF) (p=0,016). Regarding aspects related to the surgical characteristics (time elapsed from the surgery, access route, implantation site, and volume implanted), there were no significant differences in the rates of EBF over time, yet there was a significant decrease in percentage, in all groups evaluated. There was no statistical difference between the groups regarding early contact, maternal and child positioning, prehension, and suction. Over time, women who had undergone breast augmentation were less likely to show improvement in their positioning (p=0,0483) and there was a significant worsening of adequate prehension in both groups (p<0,0001). Milk abundance appeared earlier in the breast augmentation group (p=0,038), and there was no significant difference in the incidence of breast engorgement and milk production. Considering the surgical characteristics, appearance of milk, incidence of breast engorgement and milk production were not shown to be associated. The use of Oxytocin Spray was more frequent among women with breast augmentation in the first evaluation (p=0,041), and in both groups, there was a significant decrease in their use during the medical visits (p<0,0001). Over time, the use of galactagogues was more frequent in the breast augmentation group (p=0,049), and in both, there was a significant increase in its use (p<0,0001). According to the surgical characteristics, Oxytocin Spray was more frequently used by women with larger prostheses (p=0,040), while galactagogues was mostly used by those with retro pectoralis implants (p=0,029), both in the second evaluation. During the medical visits, there was a significant decrease in its use in all groups. Over time, galactagogues were more frequently used by women with an inframammary incision (p=0,0127), and there was a significant increase in their use by all groups. Artificial breasts were used mostly among women with breast augmentation at the third visit (p=0,038), as well as during the visits (p=0,0135); over time, in both groups, there was a significant increase of this practice (p<0,0001). There was no statistical difference between the groups regarding pain, pain score, or nipple lesion, and a significant decrease of these three variables was observed over time in both groups (p<0,0001). Considering the surgical aspects, the majority of the women who reported pain had a higher score and nipple lesion rates in the third evaluation, having performed the breast surgery more than 10 years ago (p=0,025, p=0,039, and p=0,021). A higher pain score in the left breast was identified among those with pre-pectoral implants at the second visit (p=0,046). Over time, all groups analyzed for time elapsed from the surgery, access route and volume implanted presented a significant decrease in pain rates and average pain score. On the other hand, the occurrence of nipple lesions showed the same decrease between the groups, followed by access route, implantation site, and size of the implanted prosthesis. Over time, there was a statistically different variation of the nipple lesion rate between the groups, according to the time elapsed from the surgery (p=0,020). Conclusion: Breast augmentation surgery and some of the characteristics interfered with breastfeeding within the first 30 days after delivery.