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Fatores associados à catastrofização da dor aguda pós-cesária e seus impactos na recuperação funcional de puérperas em pós-operatório mediato: um estudo transversal

2026-09-17T13:22:59Z

Título: Fatores associados à catastrofização da dor aguda pós-cesária e seus impactos na recuperação funcional de puérperas em pós-operatório mediato: um estudo transversal Autor(es): Pereira, Milena Santos Abstract: Introduction: Cesarean section is one of the most commonly performed surgical procedures among women of reproductive age, and acute postoperative pain is one of its most frequent complications. Acute post-cesarean pain represents a major challenge to postpartum recovery. Pain catastrophizing, characterized by a negative cognitive and emotional response to actual or anticipated pain, has been associated with greater pain intensity and impaired functional recovery. Objective: To evaluate the factors associated with acute post-cesarean pain catastrophizing and its impact on the functional recovery of women during the early postoperative postpartum period. Method: This was a cross-sectional analytical study conducted in a low-risk maternity hospital in the interior of Sergipe, Northeastern Brazil. Puerperal women in the intermediate postoperative period (≥24 h) after cesarean section were included. The primary outcome was pain catastrophizing, assessed using the 13-item Pain Catastrophizing Scale (PCS), which measures catastrophic thinking related to pain using a 5- point Likert scale. Independent variables included pain characteristics, sociodemographic, clinical, obstetric, and perioperative factors. Descriptive statistics were presented as absolute and relative frequencies. Bivariate associations were tested using Pearson’s chi-square or Fisher’s exact test, with Cramér’s V estimation. Correlations between catastrophizing and functional outcomes were assessed using Pearson’s correlation coefficient with bootstrap resampling (1,000 samples) and BCa 95% confidence intervals. The overall impact of catastrophizing on functionality was analyzed using multivariate analysis of covariance (MANCOVA), adjusted for pain intensity. Multivariate significance was evaluated using Pillai’s trace. Following a significant global effect, ANCOVAs were performed for each functional outcome, with bootstrap adjustment and Bonferroni correction. Results were expressed as estimated marginal means and effect sizes (partial eta squared, η²p), adopting a 5% significance level. Results: The sample comprised 232 puerperal women experiencing pain in the intermediate postoperative period following cesarean section, with a predominance of moderate to severe pain at the time of interview (52.6%). Most participants were younger than 35 years (79.3%), self-identified as non-White (88.8%), were users of the public health system (78.4%), unemployed (79.7%), recipients of governmental financial assistance (59.9%), and lived in owned housing (68.1%) in urban areas (56.9%). Educational level was predominantly ≥12 years of schooling (59.1%). Pain catastrophizing was correlated with functional impairments. Multivariate analysis (MANCOVA) demonstrated a significant effect of catastrophizing on functional outcomes (Pillai’s trace = 0.49; F(34,426) = 4.110; p < 0.001; ηp2 = 0.247). In the univariate analyses adjusted for pain intensity (ANCOVA), catastrophizing significantly impacted 15 of the 17 functional outcomes assessed (p < 0.05). Post hoc multiple comparisons showed that women with low levels of catastrophizing had significantly better functionality than those with high/very high levels across most outcomes, with pronounced mean differences in general activity (Mdiff = −3.36; p < 0.001), mood (Mdiff = −3.59; p < 0.001), and breastfeeding (Mdiff = −3.20; p = 0.002). Significant differences were also observed between the low and moderate catastrophizing groups, particularly regarding ambulation (p < 0.001) and newborn care activities, such as bathing (p = 0.010) and holding the infant (p = 0.013). Conclusion:Pain catastrophizing was associated with pain and functionality in the postoperative period following cesarean section. Associations were observed with gynecological-obstetric characteristics, childbirth care, and pain-related factors. A previous history of postpartum depression and labor induction increased the likelihood of elevated levels of this construct, independently of age and pain intensity. Catastrophizing significantly impacted functional outcomes, with greater impairments among women with higher levels of catastrophizing.

Proposta de protocolo para avaliação e monitoramento da função auditiva na Síndrome de Down

2026-09-04T11:28:55Z

Título: Proposta de protocolo para avaliação e monitoramento da função auditiva na Síndrome de Down Autor(es): Figueiredo, Emeline Ramos Prata Abstract: Objectives: I – To conduct an integrative review of the scientific literature on hearing assessment procedures and auditory monitoring protocols for children with Down syndrome (DS). II – To develop a proposed clinical care protocol for the assessment and monitoring of auditory function in children with DS. Methods: I – An integrative review of observational studies was conducted in the PubMed, Web of Science, Scopus, Embase, and Google Scholar databases, using the descriptors Down Syndrome, Trisomy 21, Audiological Assessment, Hearing Monitoring, Hearing Disorders, Hearing Loss, without time or language restrictions, from January to April 2025. Observational studies were included, with a sample composed of individuals diagnosed with DS and aged 12 years or younger, regardless of sex and ethnicity, that descriptively addressed the methods and protocols used in the assessment and monitoring of auditory function in children with DS. Methodological quality was assessed using the Joanna Briggs Institute's Critical Appraisal tool for Analytical Cross-Sectional Studies. II – The clinical care protocol was developed in three stages: (1) integrative review of the scientific literature; (2) development of the protocol in the form of a registration sheet; and (3) construction of a flowchart. The review identified scientific evidence on auditory assessment and monitoring in children with Down syndrome, which guided the choice of validated and appropriate objective procedures for the specificities of this population. The protocol includes the collection of identification and clinical history data, inspection of the external auditory canal, tympanometry, Auditory Brainstem Response (ABR), and Evoked Otacoustic Emissions (OAEs), and enables the diagnosis and monitoring of auditory function in children from zero to 12 years of age, regardless of active participation in the assessment. Results: I – The exploratory search in the databases resulted in 1,493 studies. After reading the titles and abstracts, 1,474 were excluded for not meeting the eligibility criteria. The 19 potentially relevant articles were evaluated in full, and eight were included in this review. The most frequently used tests were ABR and tympanometry, followed by behavioral audiometry and OAEs. The analysis revealed a lack of standardization and a shortage of specific hearing assessment and monitoring protocols for this population. II – A clinical care protocol was developed for the assessment and monitoring of auditory function in children with Down syndrome, with a graphical flowchart representation and registration sheet, which includes fields for patient identification, inspection of the external auditory canal, acoustic immittance measurements and investigation of acoustic reflex thresholds, in addition to electrophysiological evaluation through ABR and the performance of OAEs. The protocol allows for standardized recording of findings, diagnosis of the type and degree of hearing loss, and longitudinal monitoring of auditory function. Conclusion: I – The integrative review revealed the lack of standardized protocols for the assessment and monitoring of hearing in children with Down syndrome and highlighted the need for objective methods that consider their cognitive particularities, with ABR and tympanometry being the most frequently mentioned methods. II – The developed protocol presents an innovative character by establishing standardized guidelines for the evaluation and monitoring of auditory function in children with Down syndrome. It favors early diagnosis, reduces delays in intervention, and improves the quality of hearing health care by using tympanometry, ABR, and OAEs as diagnostic methods appropriate to the specificities of this population.

Proposta de instrumento de avaliação da alimentação para disfagia

2026-09-03T14:35:46Z

Título: Proposta de instrumento de avaliação da alimentação para disfagia Autor(es): Damasceno, Clara Sandes Abstract: Introduction: Feeding is a complex functional activity involving motor, sensory, cognitive, behavioral, and contextual components, with swallowing representing only one of its elements. In clinical dysphagia practice, speech-language pathology assessment remains predominantly focused on the safety and efficiency of swallowing, with limited systematization of the other aspects that influence feeding performance throughout the meal. Objective: To propose a structured instrument for the functional assessment of feeding in adult patients at risk of dysphagia. Methods: This is a methodological study developed in two stages. In the first stage, an integrative literature review was conducted through searches in the PubMed, Scopus, Web of Science, Embase, and gray literature databases, including observational and methodological studies addressing feeding assessment instruments for adults with dysphagia. In the second stage, the identified instruments were comparatively analyzed, followed by a literature search, systematization of the assessment criteria, and development of the prototype of the proposed instrument. Results: The integrative review resulted in the inclusion of four validated clinical instruments: Minimal Eating Observation Form (MEOF), Dysphagia Disorder Survey (DDS), Kuchi-Kara Taberu Index (KT Index), and Dysphagia Assessment Package (DAP). The comparative analysis showed that, although these instruments encompass relevant domains of the feeding process, their assessment criteria are distributed in a fragmented and heterogeneous manner, without operational integration aimed at the functional observation of feeding during the meal. Based on this evidence and complementary studies, the prototype of the Feeding Assessment Instrument for Dysphagia (IAAD-Fono) was developed as a comprehensive tool encompassing criteria related to overall functional status, respiratory safety, posture, dietary management, utensil handling, autonomy, feeding behavior, and food intake. Conclusion: The IAAD-Fono prototype represents a proposal aligned with the gaps identified in the literature by systematically organizing the main domains involved in the functional assessment of feeding in patients undergoing the diagnostic process for dysphagia. The instrument has the potential to broaden the speech-language pathology assessment of feeding as a continuous functional activity and to support therapeutic decision-making. Future studies should include content validation, reliability, and clinical applicability of the instrument.

Inquérito soroepidemiológico do SARS-CoV-2 em agentes de segurança pública em Sergipe, nordeste do Brasil

2026-08-31T16:27:40Z

Título: Inquérito soroepidemiológico do SARS-CoV-2 em agentes de segurança pública em Sergipe, nordeste do Brasil Autor(es): Nascimento, Laranda de Carvalho Abstract: The infection caused by SARS-Cov-2 (coronavirus) is called Coronavirus 2019 Disease (COVID-19) and is characterized by a new type of infectious disease of the respiratory tract, which has been recognized as a pandemic by the World Health Organization ( WHO) on March 11, 2020. When the disease was introduced in Brazil, most cases were imported, and the strategy to contain the epidemic was based on the search and isolation of cases and contacts to avoid the continued spread of the virus. peer to peer. However, many workers, especially in essential services, fail to adopt adequate social distance during a pandemic. In this sense, this project aimed to carry out a seroepidemiological survey of SARS-Cov-2 infection in public security agents in Aracaju-SE. For this, an observational cross-sectional study was carried out in June 2020 and January 2021, with police officers and military firefighters, respectively. Participants were submitted to a questionnaire on socio-epidemiological aspects and collection of biological material to detect the presence of SARS-Cov-2 by RT-PCR and IgM and IgG antibodies through immunofluorescence assays. The two groups of workers were composed mainly of men, aged 45 years or less and residents of Aracaju. It was possible to notice that approximately 50% of the participants of both groups had positive RT-PCR for SARS-Cov-2, 62 (44.6%) being police officers, with a seroprevalence of 3 (2.2%) for IgM and 14 ( 10.1%) for IgG and firefighters 56 (45.5%), with seropositivity for IgM of 17 (13.8%) and IgG of 32 (26.0%). In most positive cases, workers were asymptomatic. There was a significant association between seropositivity for IgM and IgG in police officers (p = 0.0268*, OR = 20.67; 95%CI = 0.03 to 0.89) and in firefighters (p = 0.0416, with OR = 3.04 and 95% CI = 1.1 - 8.7), in addition to the association between IgG and previous covid-19 test reported by firefighters (p = 0.0064, OR = 4.9 and 95% CI = 1.6 to 15.2), as well as for police officers (p = 0.0010, OR = 6.47 and 95% CI = (0.15 to 0.63). Thus, it can be seen that these professionals are routinely exposed to the risk of contamination with the new coronavirus, presenting a considerable rate of infection and increased production of antibodies between the periods evaluated. It is noteworthy that the characteristics of the work can further increase the risk of infection, so the immunization of this category is essential for the safe provision of services for workers and for society.