Publications by authors named "Silvana Andrea Molina Lima"

18 Publications

  • Page 1 of 1

Supplementation of Vitamin D in the Postdelivery Period of Women with Previous Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis of Randomized Trials.

Rev Bras Ginecol Obstet 2021 Sep 20;43(9):699-709. Epub 2021 Oct 20.

Departamento de Enfermagem, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil.

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 (HOMA-IR), 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.
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http://dx.doi.org/10.1055/s-0041-1734000DOI Listing
September 2021

Effectiveness of the pelvic floor muscle training on muscular dysfunction and pregnancy specific urinary incontinence in pregnant women with gestational diabetes mellitus: A systematic review protocol.

PLoS One 2020 7;15(12):e0241962. Epub 2020 Dec 7.

Department of Gynecology and Obstetrics, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo State, Brazil.

Background: There is ample evidence that gestational diabetes mellitus has a direct influence on urinary incontinence and pelvic floor muscles. There are no standardized pelvic floor muscle exercise programs in the literature for the physiotherapy and differ in the type of exercise, intensity, type and duration of application, and the frequency and duration of treatment sessions. The aim of this systematic review will be to investigate that Pelvic Floor Muscle Training can prevent and/or decrease the pregnancy specific urinary incontinence in women with gestational diabetes mellitus or gestational hyperglycemia.

Methods: We will perform a systematic review according to the Cochrane methodology of Randomized Controlled Trials. An overall search strategy will be developed and adapted for Embase, MEDLINE, LILACS, and CENTRAL databases, with the date of consultation until June 2020. The MeSH terms used will be "Pregnancy", "Hyperglycemia", "Diabetes Mellitus, Type 2", "Diabetes Mellitus, Type 1", "Pregnancy in Diabetics", "Diabetes, Gestational", "Urinary Incontinence", "Pelvic Floor Muscle Strength". Primary outcomes: improvement or cure of pregnancy specific urinary incontinence (which can be assessed by questionnaires, and tools such as tampon test, voiding diary, urodynamic study). Secondary outcomes: improvement of pelvic floor muscle strength (pelvic floor functional assessment, perineometer, electromyography, functional ultrasonography), improved quality of life (questionnaires), presence or absence of postpartum Urinary Incontinence and adverse effects. Quality assessment by Cochrane instrument. Metanalysis if plausible, will be performed by the software Review Manager 5.3.

Discussion: The present study will be the first to analyze the effectiveness of pelvic floor exercises in pregnant women with Gestational Diabetes Mellitus or Hyperglycemia, who suffer from pregnancy specific urinary incontinence. Randomized Controlled Trials design will be chosen because they present the highest level of evidence. It is expected to obtain robust and conclusive evidence to support clinical practice, in addition to promoting studies on the theme and contributing to new studies.

Trial Registration: Systematic review registration: PROSPERO CRD42017065281.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241962PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721159PMC
January 2021

Profile and entrepreneurial intention of nursing students: a comparison between Brazil and Chile.

Rev Bras Enferm 2020 Sep 7;73(6):e20190890. Epub 2020 Sep 7.

Universidade Estadual Paulista Júlio de Mesquita Filho. Botucatu, São Paulo, Brazil.

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.
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http://dx.doi.org/10.1590/0034-7167-2019-0890DOI Listing
September 2020

Accuracy and Effectiveness of Mammography versus Mammography and Tomosynthesis for Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis.

Sci Rep 2020 05 14;10(1):7991. Epub 2020 May 14.

Department of Internal Medicine, São Paulo State University/UNESP, Medical School, Botucatu, Sao Paulo, Brazil.

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.
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http://dx.doi.org/10.1038/s41598-020-64802-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224282PMC
May 2020

Prenatal care satisfaction: perception of caregivers with diabetes mellitus.

Rev Bras Enferm 2019 Dec;72(suppl 3):305-311

Universidade Estadual Paulista Júlio de Mesquita Filho. Botucatu, São Paulo, Brazil.

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 Clínicas, of the Faculdade de Medicina 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 follow-up.

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.
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http://dx.doi.org/10.1590/0034-7167-2018-0978DOI Listing
December 2019

Quality of life in patients who undergo conventional or robotic-assisted total laparoscopic hysterectomy: Protocol for a systematic review of randomized controlled trials.

Medicine (Baltimore) 2019 Jun;98(23):e15974

Department of Nursing, São Paulo State University (UNESP), Medical School, Botucatu.

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.
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http://dx.doi.org/10.1097/MD.0000000000015974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571212PMC
June 2019

Entrepreneurship and Nursing: integrative review.

Rev Bras Enferm 2019 Feb;72(suppl 1):321-330

Universidade Estadual Paulista Julio de Mesquita Filho. Botucatu, São Paulo, Brazil.

Objective: To identify the knowledge produced on business entrepreneurship in Nursing.

Method: Integrative literature review in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, SCOPUS, Web of Science, PubMed, Medline, Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Database (BDENF), Index Psychology and National Information Center of Medical Sciences of Cuba (CUMED). We included available studies in their totality in the period from 2007 to 2017.

Results: 22 articles were included. The categories that emerged from the study are the following: Concepts of entrepreneurship in nursing, Profile of the entrepreneur nurse, Business Diversity, Business Management, Barriers to business entrepreneurship in nursing, Support to entrepreneurial nurses and Entrepreneurship in Nursing Undergraduate.

Conclusion: There is a need to prepare nurses with adequate skills to increase the capacity to integrate into the labor market and to improve their own well-being and that of society.
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http://dx.doi.org/10.1590/0034-7167-2018-0498DOI Listing
February 2019

Efficacy of vitamin D supplementation in gestational diabetes mellitus: Systematic review and meta-analysis of randomized trials.

PLoS One 2019 22;14(3):e0213006. Epub 2019 Mar 22.

Department of Gynecology and Obstetrics, São Paulo State University (UNESP), Medical School, Botucatu, São Paulo, Brazil.

Background: Trials have examined on the benefits of vitamin D supplementation in pregnant women.

Objective: This 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.

Method: We 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).

Results: The 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.

Conclusion: We 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.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0213006PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430411PMC
December 2019

Incident analysis occurrence related to potentially dangerous medicines distributed in teaching hospital.

Rev Gaucha Enferm 2019 Jan 10;40(spe):e20180220. Epub 2019 Jan 10.

Hospital das Clínicas da Faculdade de Medicina de Botucatu (HCFMB). Botucatu, São Paulo, Brasil.

Objective: To analyze the reports of incidents related to potentially hazardous medications distributed at a teaching hospital in the interior of São Paulo.

Methods: A descriptive, retrospective study with a quantitative approach of data from the analysis of pharmacovigilance notifications that occurred between January 2009 and December 2014, from tables and graphs, showing the absolute/relative frequencies.

Results: From 786 reports of pharmacovigilance, 188 were related to potentially hazardous medicines, 36.7% of which were ineffective, 32.44% were technical complaints, 15.95% were adverse reactions, 7.44% were phlebitis, 5.13% were extravasation , 1.06% dispensing error, 0.53% administration error and 0.53% medication error. The professionals who most notified were nurses. The most commonly reported pharmacological groups were drugs with action on the nervous system (35.63%).

Conclusion: The analysis showed that there were a significant number of reports and the need to adopt strategies to ensure greater patient safety.
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http://dx.doi.org/10.1590/1983-1447.2019.20180220DOI Listing
January 2019

Is the risk of low birth weight or preterm labor greater when maternal stress is experienced during pregnancy? A systematic review and meta-analysis of cohort studies.

PLoS One 2018 26;13(7):e0200594. Epub 2018 Jul 26.

Nursing Department of Gynecology and Obstetrics, Universidade Estadual Paulista (Unesp) Botucatu Medical School, UNESP, Botucatu, Brazil.

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: MEDLINE (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.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200594PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061976PMC
January 2019

Homemade diet versusdiet industrialized for patients using alternative feeding tube at home - An integrative review.

Nutr Hosp 2017 Nov 14;34(5):1281-1287. Epub 2017 Nov 14.

São Paulo State University (UNESP), Medical School, Botucatu.

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.
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http://dx.doi.org/10.20960/nh.1301DOI Listing
November 2017

Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials.

Sao Paulo Med J 2017 Mar-Apr;135(2):123-132. Epub 2017 Apr 20.

MD, PhD. Titular Professor, Department of Gynecology and Obstetrics, Universidade Estadual Paulista (UNESP), Botucatu (SP), Brazil.

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.
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http://dx.doi.org/10.1590/1516-3180.2016.0267031116DOI Listing
October 2017

Depression and anxiety in pregnant women with diabetes or mild hyperglycemia.

Arch Gynecol Obstet 2016 Apr 25;293(4):833-7. Epub 2015 Sep 25.

Department of Nursing, Hospital of the Botucatu Medical School (FMB), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil.

Introduction: 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.

Method: 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.

Results: 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.

Conclusion: 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.
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http://dx.doi.org/10.1007/s00404-015-3838-3DOI Listing
April 2016

The reasons of the nursing staff to notify adverse events.

Rev Lat Am Enfermagem 2014 Oct;22(5):747-54

Departamento de Enfermagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil.

Objective: This research aimed to understand the motivation for reporting adverse events from the perspective of nursing staff in the work environment.

Method: Qualitative study that used the phenomenology of Alfred Schutz for reference, which offers a systematic approach to understand the social aspects of human action. Data were collected by open interviews with 17 nurses and 14 technicians/assistant nurses in a university hospital.

Results: Motivation was revealed through six categories: all types of occurrences must be reported; the incident report is an auxiliary instrument to health care provision management; the culture of punishment in transition; nurses as the agents responsible for voluntary reporting; sharing problems with higher management and achieving quality in the work process.

Discussion: It was unveiled that, when reporting adverse events, team members perceived themselves to be in a collaborative relationship with the institution and trusted that they would receive administrative support and professional security, which encouraged them to continue reporting. Reporting allows health care professionals to share responsibilities with managers and encourages corrective actions.

Final Considerations: The study revealed the nursing staff's motivation for adverse event reporting, contributing to reflections on institutional policies aimed at patient safety in health care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4292683PMC
http://dx.doi.org/10.1590/0104-1169.3556.2476DOI Listing
October 2014

Effect of ambulatory versus hospital treatment for gestational diabetes or hyperglycemia on infant mortality rates: a systematic review.

Sao Paulo Med J 2013 ;131(5):331-7

Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Department of Gynecology and Obstetrics, BotucatuSão PauloBrazil.

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.
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http://dx.doi.org/10.1590/1516-3180.2013.1315560DOI Listing
October 2014

[National Policy of Humanization and education of health care professionals: integrative review].

Rev Bras Enferm 2013 Jan-Feb;66(1):123-7

Departamento de Enfermagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.

The National Policy of Humanization aims at innovations in health production, management and care with emphasis on permanent education for workers in the Unified Public Health System and training of university students in the health care field. This study aimed to know, through an integrative review of the literature, the scientific production about the National Policy of Humanization and education of health care professionals, from 2002 to 2010. Ten articles were analyzed in thematic strand through three axes: humanization and users caring, humanization and the work process, humanization and training. The articles point to the need to overcome the biological conception, valuing cultural aspects of users. The work process is marked by the devaluation of workers and by users deprived of their rights. The training of health professionals is grounded in health services where the prevailing standards are practices that hinder innovative attitudes.
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http://dx.doi.org/10.1590/s0034-71672013000100019DOI Listing
March 2014

Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil.

Sao Paulo Med J 2012 ;130(1):17-26

Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.

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.
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http://dx.doi.org/10.1590/s1516-31802012000100004DOI Listing
October 2012

Care cost for pregnant and parturient women with diabetes and mild hyperglycemia.

Rev Saude Publica 2012 Apr 3;46(2):334-43. Epub 2012 Feb 3.

Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil.

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.
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http://dx.doi.org/10.1590/s0034-89102012005000009DOI Listing
April 2012
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