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1.
Front Psychol ; 15: 1310594, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38659692

RESUMO

Introduction: The COVID-19 pandemic led many countries to adopt strict measures aimed at reducing circulation of the virus and mitigating the burden on health services. Among these, the lockdown (social distancing/confinement) was probably the most controversial and most widely debated, since it affected the population's daily life abruptly, with consequences for people's emotional state and the operational logic of various economic sectors. Objective: Analyze the relationship been Brazilians' opinions on lockdown during the pandemic and individual, sociodemographic, and belief characteristics. Methods: We conducted an online survey to evaluate Brazilians' opinions on the lockdown during the COVID-19 pandemic. We prepared a questionnaire with questions on sociodemographic aspects and individuals' points of view toward the lockdown. We sent a link for the survey through social media and encouraged participants to also share the link in their respective social networks, as a snowball sample. Cluster analysis was performed to identify different opinion profiles. Cluster Analysis is a multivariate approach that aims to segment a set of data into distinct groups, using some classification criteria. Results: From April to May 2021, the link received 33,796 free participations via social networks from all over Brazil. We analyzed data from 33,363 participants. Pro-lockdown opinions predominated in most of the sociodemographic strata. Cluster analysis identified two groups: pro-lockdown, aligned with the scientific recommendations, and anti-lockdown, characterized by economic insecurity and denialism. Anti-lockdown participants downplayed the pandemic's seriousness and believed in unproven measures to fight SARS-CoV-2. However, these same participants were afraid of losing their jobs and of being unable to pay their bills. In general, participants did not believe in the feasibility of a lockdown in Brazil or in the efficacy of the prevailing government administration's measures. Conclusion: The study identified a lack of consensus among participants concerning lockdown as a practice. Issues such as disbelief in the pandemic's seriousness, denialism, and economic insecurity were important in the determination of the profiles identified in the study. Denialism is believed to have been a subjective defense against the economic problems resulting from social control measures and the lack of adequate social policies to deal with the pandemic. It was also highlighted that political polarization and the lack of central coordination during social distancing are crucial aspects. The variation in results in different locations highlights the diversity of the Brazilian scenario. By analyzing Brazilians' opinions about the lockdown, considering individual characteristics, the study seeks insights to face the pandemic and prepare for future crises, contributing to more effective public health strategies.

2.
Cad Saude Publica ; 39(10): e00159122, 2023.
Artigo em Português | MEDLINE | ID: mdl-37851730

RESUMO

The objective is to unveil the reasons for vaccine hesitancy among parents and/or guardians of children and adolescents toward the prevention of COVID-19. This is a descriptive study, with a qualitative approach that seeks to analyze the answers to the open question "Why will you not vaccinate or have not vaccinated or are in doubt about vaccinating the children and adolescents under your responsibility, for the prevention of COVID-19?". The research included adult individuals, Brazilians, living in the country, responsible for children and adolescents under 18 years of age. Data collection took place electronically in November and December 2021. The answers were organized and processed with the support of the software Iramuteq. The textual corpus of this research was composed of the response of 1,896 participants, consisting of 87% who were hesitant (1,650) and 13% (246) of parents who intend to vaccinate but who outlined some doubts and considerations about the vaccination of children and adolescents. These are reasons why parents and/or guardians have not vaccinated or are in doubt about vaccinating the children and adolescents under their responsibility for the prevention of COVID-19: fears about vaccination regarding the conception that the vaccine is in the experimental phase, fear of adverse reactions and long-term effects. The reasons for the lack of intention to vaccinate stem from the understanding of the participants that COVID-19 in children is not serious, the risks of vaccination are greater than the benefits, and the right of choice not to vaccinate.


Objetiva-se desvelar os motivos para hesitação vacinal de pais e/ou responsáveis de crianças e adolescentes para prevenção da COVID-19. Trata-se de um estudo descritivo, de abordagem qualitativa, que busca analisar as respostas da pergunta aberta "por que você não vai vacinar, não vacinou ou está na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19?". A pesquisa incluiu indivíduos adultos, brasileiros, residentes no país, responsáveis por crianças e adolescentes menores de 18 anos. A coleta de dados aconteceu de forma eletrônica entre os meses de novembro e dezembro de 2021. As respostas foram organizadas e processadas com suporte do software Iramuteq. O corpus textual desta pesquisa foi composto pela resposta de 1.896 participantes, constituído por 87% de hesitantes (1.650) e 13% (246) de pais que têm intenção de vacinar, mas que esboçaram algumas dúvidas e considerações a respeito da vacinação de crianças e adolescentes. São motivos pelos quais pais e/ou responsáveis não vacinaram ou estão na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19: receio em razão de a vacina estar em fase experimental e medo das reações adversas e dos efeitos a longo prazo. Já os motivos para ausência de intenção de vacinar decorrem dos entendimentos dos participantes de que a COVID-19 em crianças não é grave, os riscos da vacinação são maiores do que os benefícios e o direito de escolha em não vacinar.


El objetivo es revelar los motivos de la indecisión a las vacunas de padres y/o responsables de niños y adolescentes para la prevención de COVID-19. Se trata de un estudio descriptivo con enfoque cualitativo, que busca analizar las respuestas a la pregunta abierta "¿Por qué no va a vacunar o no vacunó o tiene dudas en vacunar a los niños y los adolescentes bajo su responsabilidad para la prevención del COVID-19?". La investigación incluyó individuos adultos, brasileños, residentes en el país, responsables de niños y adolescentes menores de 18 años. La recolección de datos se realizó de forma electrónica entre los meses de noviembre y diciembre de 2021. Las respuestas se organizaron y procesaron con ayuda del software Iramuteq. El corpus textual de esta investigación fue compuesto por la respuesta de 1.896 participantes, siendo constituido por el 87% de indecisos (1.650) y el 13% (246) de padres que tienen la intención de vacunar, pero que esbozaron algunas dudas y consideraciones respecto a la vacunación de niños y adolescentes. Son motivos por los cuales los padres y/o responsables no vacunaron o están en duda en vacunar a los niños y adolescentes bajo su responsabilidad para prevención del COVID-19: temores con la vacunación en cuanto a la concepción de que la vacuna está en fase experimental, miedo a las reacciones adversas y los efectos a largo plazo. Los motivos de la ausencia de intención en vacunar se deben a que los participantes entienden que el COVID-19 en niños no es grave, que los riesgos de la vacunación son mayores que los beneficios y que tienen derecho a decidir no vacunarse.


Assuntos
COVID-19 , Hesitação Vacinal , Adulto , Humanos , Adolescente , Criança , Brasil/epidemiologia , COVID-19/prevenção & controle , Coleta de Dados , Emoções , Pais , Vacinação
3.
Cien Saude Colet ; 28(10): 3069-3076, 2023 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-37878947

RESUMO

The mental health of health professionals who worked directly in services during the COVID-19 pandemic to care for patients affected by the disease became a fundamental issue to be considered, given the several consequences of this activity for these professionals. This article aimed to understand the challenges and demands of health professionals concerning support to address the emotional and physical exhaustion of working on the so-called frontline during the COVID-19 pandemic. The qualitative methodological approach was based on semi-structured interviews conducted online with these professionals after the first months of the pandemic. The hero's place in which they were set, even if only in media discourses, soon gave way to their weaknesses and fragile work relationships to emerge: stress, fear, and the listening and reception desire. Marcel Mauss' gift theory was brought up considering that new ways of reading and interpreting health work relationships contribute to necessary and urgent reformulations of their current context, targeting mental health and, more broadly, the comprehensive health of healthcare professionals.


Durante a pandemia de COVID-19, a saúde mental dos profissionais de saúde, que trabalharam diretamente nos serviços voltados para o cuidado dos pacientes afetados pela doença, tornou-se questão fundamental a ser considerada, dado os diversos desdobramentos que essa atuação gerou para esses profissionais. O objetivo deste artigo foi compreender desafios e demandas dos profissionais de saúde em termos de suporte para lidar com o desgaste emocional e físico com a atuação na chamada linha de frente durante a pandemia de COVID-19. A abordagem metodológica qualitativa se deu a partir de entrevistas semiestruturadas realizadas em ambiente online com esses profissionais, passados os primeiros meses de pandemia. O lugar de herói em que eles foram colocados, ainda que apenas nos discursos midiáticos, logo deu espaço para que as fragilidades destes e das relações de trabalho aparecessem: estresse, medo e o desejo de escuta e acolhimento. A teoria da dádiva de Marcel Mauss foi trazida considerando que novas formas de leitura e interpretação das relações de trabalho em saúde contribuem para reformulações necessárias e urgentes do contexto em que se encontram hoje, visando a saúde mental e, mais amplamente, a saúde integral dos profissionais da área de saúde.


Assuntos
COVID-19 , Humanos , Saúde Mental , Pandemias , Pessoal de Saúde , Atenção à Saúde
4.
Ciênc. Saúde Colet. (Impr.) ; Ciênc. Saúde Colet. (Impr.);28(10): 3069-3076, out. 2023. tab
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1520594

RESUMO

Resumo Durante a pandemia de COVID-19, a saúde mental dos profissionais de saúde, que trabalharam diretamente nos serviços voltados para o cuidado dos pacientes afetados pela doença, tornou-se questão fundamental a ser considerada, dado os diversos desdobramentos que essa atuação gerou para esses profissionais. O objetivo deste artigo foi compreender desafios e demandas dos profissionais de saúde em termos de suporte para lidar com o desgaste emocional e físico com a atuação na chamada linha de frente durante a pandemia de COVID-19. A abordagem metodológica qualitativa se deu a partir de entrevistas semiestruturadas realizadas em ambiente online com esses profissionais, passados os primeiros meses de pandemia. O lugar de herói em que eles foram colocados, ainda que apenas nos discursos midiáticos, logo deu espaço para que as fragilidades destes e das relações de trabalho aparecessem: estresse, medo e o desejo de escuta e acolhimento. A teoria da dádiva de Marcel Mauss foi trazida considerando que novas formas de leitura e interpretação das relações de trabalho em saúde contribuem para reformulações necessárias e urgentes do contexto em que se encontram hoje, visando a saúde mental e, mais amplamente, a saúde integral dos profissionais da área de saúde.


Abstract The mental health of health professionals who worked directly in services during the COVID-19 pandemic to care for patients affected by the disease became a fundamental issue to be considered, given the several consequences of this activity for these professionals. This article aimed to understand the challenges and demands of health professionals concerning support to address the emotional and physical exhaustion of working on the so-called frontline during the COVID-19 pandemic. The qualitative methodological approach was based on semi-structured interviews conducted online with these professionals after the first months of the pandemic. The hero's place in which they were set, even if only in media discourses, soon gave way to their weaknesses and fragile work relationships to emerge: stress, fear, and the listening and reception desire. Marcel Mauss' gift theory was brought up considering that new ways of reading and interpreting health work relationships contribute to necessary and urgent reformulations of their current context, targeting mental health and, more broadly, the comprehensive health of healthcare professionals.

5.
Artigo em Inglês | MEDLINE | ID: mdl-37444052

RESUMO

BACKGROUND: The control of the COVID-19 pandemic has been a great challenge. Understanding the thoughts and beliefs underlying vaccine hesitancy can help in the formulation of public policies. The present study aimed to analyze the social representations of hesitant Brazilians about vaccination against COVID-19. METHODS: Qualitative research guided by the Theory of Social Representations, carried out through an online survey among Brazilian adults living in Brazil. The data were analyzed using the IRaMuTeQ software. RESULTS: Of the 173,178 respondents, 10,928 were hesitant and declared reasons for vaccination hesitation. The analysis generated three classes: mistrust of the vaccine and underestimation of the severity of the pandemic; (dis)information and distrust of political involvement; and fear of adverse reactions to COVID-19 vaccines. CONCLUSIONS: Social knowledge, presented by the representations apprehended in this study, demonstrates difficulty in discerning the reliability of information and a social imagination full of doubts and uncertainties. Understanding the internal dynamics of these groups, with their representations of the world, is important to propose policies and actions that echo and cause changes in the understanding of the role of immunization. It is essential to shed light on the sociological imagination so that gaps filled with false information can be dismantled and confronted with scientific knowledge accessible to the population.


Assuntos
COVID-19 , Hesitação Vacinal , Adulto , Humanos , Brasil , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Pandemias/prevenção & controle , Política Pública , Reprodutibilidade dos Testes , Vacinação , Hesitação Vacinal/psicologia
6.
PLoS One ; 18(1): e0279393, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36595513

RESUMO

OBJECTIVE: This study aims to assess the trustworthiness of information sources, perception of clear information about the vaccine, and strategies to increase adherence to vaccination to provide managers with information that helps establish effective communication with the population about vaccination. METHOD: This is an online survey conducted between January 22 and 29, 2021, preceded by an Informed Consent, that aims to assess vaccine hesitancy, which corresponded to the first week of vaccination initiation to prevent COVID-19 in Brazil. Data were obtained from a questionnaire made available through a free platform and stored in Google Forms and later exported to the SPSS statistical package for analysis. The sample consisted of all questionnaires from participants who self-declared as age 18 or older, Brazilian, and residing in Brazil at the time of the survey. Incomplete records with more than 50% of blank items and duplicates were excluded. All categorical variables were analyzed from their absolute and relative frequencies. Multivariate logistic regression was performed to verify the relationship between dependent variables and independent variables. RESULTS: The results show that trust in information sources diverges between hesitant and non-hesitant. They also showed that some participants show an overall distrust that seems to have deeper foundations than issues related only to the source of information. The high rejection of television and the WHO as sources of information among hesitant suggests that integrated actions with research institutes, public figures vaccinating, and religious leaders can help to combat vaccine hesitation. Two actors become particularly important in this dynamic, both for good and bad, and their anti-vaxxer behavior must be observed: the doctor and the Ministry of Health. CONCLUSION: This study contributes to gathering valuable information to help understand the behavior and thinking relevant to the adherence to vaccination recommendations.


Assuntos
COVID-19 , Vacinas , Humanos , Adolescente , Fonte de Informação , Brasil/epidemiologia , Vacinas contra COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinação
7.
Vaccine ; 41(3): 735-743, 2023 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-36549940

RESUMO

BACKGROUND: The vaccination of children and adolescents for the prevention of Covid-19 is important to:decrease in deaths and hospitalizations, prevent multisystem inflammatory syndrome, avoid long-term complications and decrease the suspension of on-site classes. Despite of these benefits, some studies have shown that some caregivers are still hesitancy. METHODS: This is a voluntary and anonymous online survey conducted from November 17 to December 14, 2021, in Brazil, through a free-of-charge platform with a link provided on social networks. A bivariate analysis was conducted with the independent variables, with vaccine hesitancy as the outcome variable, and a multivariate logistic model was used to calculated adjusted odds ratios. RESULTS: The sample included 15,297 respondents. Approximately 13.3 % (2,028) of the caregivers were hesitant to vaccinate their children and adolescents against Covid-19 in at least one age group. The vaccination hesitanty rate of caregivers of children aged 0-4 years, 5-11 years and adolescents were 16 %, 13 %, 15 %, respectively. The principal factors associated with vaccine hesitancy were the following: belief that they need to wait longer, belief that children that had natural infection doesn't need to vaccinate and belief that vaccine has long term adverse effects. INTERPRETATION: The present study showed that the willingness of caregivers to have their children and adolescents vaccinated in Brazil is high compared to data from adult and pediatric international studies. This study provides a profile of the hesitant caregivers considering their perspectives and beliefs regarding vaccines that can help the elaboration of strategies to increase vaccine adherence.


Assuntos
COVID-19 , Adulto , Humanos , Adolescente , Criança , Lactente , COVID-19/prevenção & controle , Brasil , Cuidadores , Hospitalização , Vacinação , Pais
8.
Cad. Saúde Pública (Online) ; 39(10): e00159122, 2023. graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-1550172

RESUMO

Resumo: Objetiva-se desvelar os motivos para hesitação vacinal de pais e/ou responsáveis de crianças e adolescentes para prevenção da COVID-19. Trata-se de um estudo descritivo, de abordagem qualitativa, que busca analisar as respostas da pergunta aberta "por que você não vai vacinar, não vacinou ou está na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19?". A pesquisa incluiu indivíduos adultos, brasileiros, residentes no país, responsáveis por crianças e adolescentes menores de 18 anos. A coleta de dados aconteceu de forma eletrônica entre os meses de novembro e dezembro de 2021. As respostas foram organizadas e processadas com suporte do software Iramuteq. O corpus textual desta pesquisa foi composto pela resposta de 1.896 participantes, constituído por 87% de hesitantes (1.650) e 13% (246) de pais que têm intenção de vacinar, mas que esboçaram algumas dúvidas e considerações a respeito da vacinação de crianças e adolescentes. São motivos pelos quais pais e/ou responsáveis não vacinaram ou estão na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19: receio em razão de a vacina estar em fase experimental e medo das reações adversas e dos efeitos a longo prazo. Já os motivos para ausência de intenção de vacinar decorrem dos entendimentos dos participantes de que a COVID-19 em crianças não é grave, os riscos da vacinação são maiores do que os benefícios e o direito de escolha em não vacinar.


Abstract: The objective is to unveil the reasons for vaccine hesitancy among parents and/or guardians of children and adolescents toward the prevention of COVID-19. This is a descriptive study, with a qualitative approach that seeks to analyze the answers to the open question "Why will you not vaccinate or have not vaccinated or are in doubt about vaccinating the children and adolescents under your responsibility, for the prevention of COVID-19?". The research included adult individuals, Brazilians, living in the country, responsible for children and adolescents under 18 years of age. Data collection took place electronically in November and December 2021. The answers were organized and processed with the support of the software Iramuteq. The textual corpus of this research was composed of the response of 1,896 participants, consisting of 87% who were hesitant (1,650) and 13% (246) of parents who intend to vaccinate but who outlined some doubts and considerations about the vaccination of children and adolescents. These are reasons why parents and/or guardians have not vaccinated or are in doubt about vaccinating the children and adolescents under their responsibility for the prevention of COVID-19: fears about vaccination regarding the conception that the vaccine is in the experimental phase, fear of adverse reactions and long-term effects. The reasons for the lack of intention to vaccinate stem from the understanding of the participants that COVID-19 in children is not serious, the risks of vaccination are greater than the benefits, and the right of choice not to vaccinate.


Resumen: El objetivo es revelar los motivos de la indecisión a las vacunas de padres y/o responsables de niños y adolescentes para la prevención de COVID-19. Se trata de un estudio descriptivo con enfoque cualitativo, que busca analizar las respuestas a la pregunta abierta "¿Por qué no va a vacunar o no vacunó o tiene dudas en vacunar a los niños y los adolescentes bajo su responsabilidad para la prevención del COVID-19?". La investigación incluyó individuos adultos, brasileños, residentes en el país, responsables de niños y adolescentes menores de 18 años. La recolección de datos se realizó de forma electrónica entre los meses de noviembre y diciembre de 2021. Las respuestas se organizaron y procesaron con ayuda del software Iramuteq. El corpus textual de esta investigación fue compuesto por la respuesta de 1.896 participantes, siendo constituido por el 87% de indecisos (1.650) y el 13% (246) de padres que tienen la intención de vacunar, pero que esbozaron algunas dudas y consideraciones respecto a la vacunación de niños y adolescentes. Son motivos por los cuales los padres y/o responsables no vacunaron o están en duda en vacunar a los niños y adolescentes bajo su responsabilidad para prevención del COVID-19: temores con la vacunación en cuanto a la concepción de que la vacuna está en fase experimental, miedo a las reacciones adversas y los efectos a largo plazo. Los motivos de la ausencia de intención en vacunar se deben a que los participantes entienden que el COVID-19 en niños no es grave, que los riesgos de la vacunación son mayores que los beneficios y que tienen derecho a decidir no vacunarse.

9.
PLoS One ; 17(1): e0261814, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35061719

RESUMO

Brazil has been severely affected by the COVID-19 pandemic. The high numbers of confirmed cases and deaths have continued unabated since the first reported case, with no flattening or downward turn in the curve. In this context, healthcare workers have been exposed uninterruptedly to stress factors throughout a year of the pandemic. The study´s aim was to identify and analyze healthcare workers´ perceptions of their feelings and concerns that have surfaced in responding to the pandemic. METHOD: This was a cross-sectional online qualitative survey study of 554 healthcare personnel working in the state of Rio de Janeiro during the COVID-19 pandemic. Recruitment occurred from July 20 to September 30, 2020, using an online survey, preceded byfree informed consent term. Data were analyzed with the Iramuteq software. RESULTS: Through a dendrogram, the words with the highest chi-square were highlighted and grouped into four classes: healthcare workers´ fear of falling ill to COVID-19 and infecting their family members; work/labor issues; feelings of powerlessness and need for public policies for government action; and fatigue and burnout in the pandemic. Each word class was also illustrated by a similarity tree. CONCLUSION: The study revealed healthcare workers´ exacerbated fear of infection and transmission of COVID-19 to their family members, besides financial losses and feelings of powerlessness and abandonment.


Assuntos
Esgotamento Profissional/epidemiologia , COVID-19/psicologia , Medo/psicologia , Pessoal de Saúde/psicologia , Adolescente , Adulto , Brasil , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
10.
Rio de Janeiro; s.n; 2022. 181 p. ilus, graf, tab.
Tese em Português | LILACS | ID: biblio-1551790

RESUMO

O Brasil tem sido severamente afetado pela pandemia da COVID-19. Nesse contexto, profissionais de saúde permanecem expostos a fatores estressores por um longo período de pandemia, deixando-os no limite físico e emocional. Estes profissionais são submetidos à sobrecarga e longas jornadas de trabalho, dilemas morais, perdas financeiras, uma exposição constante e prolongada a riscos biológicos no enfrentamento da COVID-19 e medo de transmissão familiar da doença. Neste cenário pensou-se em desenvolver esta pesquisa trazendo como objetivo: Avaliar a repercussão da pandemia da COVID-19 nos profissionais de saúde. Método: Trata-se de um estudo exploratório, descritivo, quanti e qualitativo. Os participantes foram profissionais de saúde, que trabalharam no Estado do Rio de Janeiro durante a pandemia da COVID-19. O recrutamento ocorreu de 20/07 a 30/09/2020, através de um inquérito eletrônico, antecedido por um Consentimento Livre e Esclarecido online. Os dados foram tratados pelo software IRaMuTeQ, e executadas análises textuais. O estudo apoia-se teoricamente nos conceitos desenvolvidos pelo sociólogo Pierre Bourdieu. Resultados: Foram inseridos no estudo 554 participantes. Os dados provenientes do formulário do estudo foram organizados e tratados a partir de estatística simples descritiva, para caracterizar os sujeitos e processados pelo IRaMuTeQ. A Classificação Hierárquica Descendente (CHD) foi finalizada em 4 classes: Classe 1 ­ O medo dos profissionais de adoecer e contaminar familiares; Classe 2 ­ Questões laborais; Classe 3 ­ Sentimento de impotência e a necessidade de políticas públicas e ações governamentais e Classe 4 ­ Cansaço e exaustão na pandemia. Conclusão: O estudo revelou o medo exacerbado dos trabalhadores da saúde de serem infectados pelo SRA-CoV-2 e de transmitirem a infecção às suas famílias, além de perdas financeiras e sentimento de impotência e abandono. Estes sentimentos foram agravados pela falta de direção política ou de implementação de medidas eficazes para minimizar e controlar a propagação da doença. Alguns destes profissionais de saúde manifestaram sinais de doença física e emocional, evidenciando uma segunda pandemia silenciosa, de sentimentos negativos, estresse prolongado, sobrecarga de trabalho e fadiga. A persistência da pandemia gerou como conseqüência sobrecarga física e mental dos profissionais de saúde. Ao observarmos os pontos centrais das quatro classes geradas pela CHD, identificamos que convergem em uma violência simbólica direcionada da instância federal (dominadora) aos profissionais da saúde (dominados) que estavam na ponta da assistência na pandemia da COVID-19. As diferentes categorias da área da saúde independente do capital acumulado e do campo de atuação aproximavam-se pelo seu habitus incorporado e identificavam uma necessidade de mudança resolutiva do cenário da pandemia, mas que estava inacessível a eles por derem os dominados. É válido avaliar os relatos destes profissionais, ouvir suas percepções, detectar sinais de alerta, de violência simbólica e promover uma possível intervenção precoce de apoio emocional durante e após a pandemia, configurando uma medida de cuidado em saúde para esta classe profissional. É necessário cuidar da saúde dos trabalhadores que prestam assistência direta aos pacientes, principalmente dentro do contexto de pandemias, zelando por sua proteção, direitos e sua saúde mental.


Brazil has been severely affected by the pandemic of COVID-19. In this context, health professionals remain exposed to stressful factors for a long pandemic period, leaving them at their physical and emotional limits. These professionals are submitted to overload and long working hours, moral dilemmas, financial losses, a constant and prolonged exposure to biological risks when facing COVID-19 and fear of family transmission of the disease. In this scenario, this research was developed with the following objective: To evaluate the repercussions of the pandemic of COVID-19 on healthcare professionals. Method: This is an exploratory, descriptive, quantitative and qualitative study. The participants were healthcare professionals, who worked in the state of Rio de Janeiro during the COVID-19 pandemic. Recruitment occurred from 07/2020 to 09/30/2020, through an electronic survey, preceded by an online Informed Consent. Data were processed by IRaMuTeQ software, and textual analyses were performed. The study is theoretically based on the concepts developed by sociologist Pierre Bourdieu. Results: 554 participants were enrolled in the study. Data from the study form were organized and processed from simple descriptive statistics to characterize the subjects and processed by IRaMuTeQ. The Descending Hierarchical Classification (CHD) was finalized in 4 classes: Class 1 - Professionals' fear of getting sick and contaminating family members; Class 2 - Work issues; Class 3 - Feeling of helplessness and the need for public policies and governmental actions; and Class 4 - Tiredness and exhaustion in the pandemic. Conclusion: The study revealed health care workers' exacerbated fear of being infected by SARS-CoV-2 and of transmitting the infection to their families, in addition to financial losses and feelings of helplessness and abandonment. These feelings were compounded by the lack of policy direction or implementation of effective measures to minimize and control the spread of the disease. Some of these health professionals manifested signs of physical and emotional illness, evidencing a second silent pandemic of negative feelings, prolonged stress, work overload, and fatigue. The persistence of the pandemic generated as a consequence the physical and mental overload of health professionals. When we observe the central points of the four classes generated by the CHD, we identify that they converge in a symbolic violence directed by the federal instance (dominant) to health professionals (dominated) who were at the point of assistance in the pandemic of COVID-19. The different categories of the health area, regardless of their accumulated capital and field of action, were approached by their incorporated habitus and identified a need for resolutive change in the pandemic scenario, but which was inaccessible to them because they were the dominated ones. It is valid to evaluate the reports of these professionals, listen to their perceptions, detect warning signs of symbolic violence, and promote a possible early intervention of emotional support during and after the pandemic, configuring a health care measure for this professional class. It is necessary to care for the health of workers who provide direct assistance to patients, especially within the context of pandemics, watching over their protection, rights, and their mental health.


Assuntos
Humanos , Jornada de Trabalho , Saúde Ocupacional , Pessoal de Saúde , SARS-CoV-2 , COVID-19/psicologia , COVID-19/epidemiologia , Brasil/epidemiologia , Inquéritos e Questionários
11.
Vaccine ; 39(42): 6262-6268, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34535318

RESUMO

BACKGROUND: The COVID-19 pandemic has affected the entire world, and the vaccine has emerged as a source of hope for return to normal life. Still, various countries have reported high vaccine hesitancy rates. It is important to know the vaccine hesitancy profile in Brazil to help design adequate communication strategies. METHODS: A voluntary, anonymous online survey was conducted from January 22 to 29, 2021, including resident Brazilian adults to assess factors related to vaccine hesitancy. Sociodemographic and epidemiological data were analyzed. A bivariate analysis was conducted with the independent variables, with vaccine hesitancy as the outcome variable, and a multivariate logistic model was used to calculated adjusted odds ratios. RESULTS: The sample included 173,178 respondents, and vaccine hesitancy was found in 10.5%. The principal factors associated with vaccine hesitancy were the following: assigning importance to the vaccinés efficacy (AOR = 16.39), fear of adverse reactions (AOR = 11.23), and assigning importance to the vaccinés country of origin (AOR = 3.72). Other risk factors were the following: male gender (AOR = 1.62), having children (AOR = 1.29), 9 years of schooling or less (AOR = 1.31), living in the Central-West region (AOR = 1.19), age ≥ 40 years (AOR = 1.17), and monthly income < U$788.68 (AOR = 1.13). The two vaccines available in Brazil, Covishield and CoronaVac, showed similar confidence, 80.13% and 76.36%, respectively, despite the higher rejection of the latter vaccinés Chinese origin. INTERPRETATION: This online survey confirms the low vaccine hesitancy rate among Brazilians and allowed the identification of a profile that can assist the elaboration of communication strategies to increase vaccine adherence. FUNDING: National Institute of Women, Children and Adolescents Health Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brazil.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adolescente , Adulto , Brasil , Criança , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2
12.
Rev Soc Bras Med Trop ; 54: e0865-2020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33759933

RESUMO

This report describes a case of multisystem inflammatory syndrome in a child that evolved with a pattern of toxic shock syndrome with coronary artery ectasia and neurological involvement, documented by magnetic resonance imaging, with changes in the corpus callosum and myopathy in the pelvic girdle and paravertebral musculature.


Assuntos
COVID-19 , Doenças Musculares , Criança , Humanos , Imageamento por Ressonância Magnética , Doenças Musculares/diagnóstico , SARS-CoV-2 , Síndrome , Síndrome de Resposta Inflamatória Sistêmica
13.
Rev. Soc. Bras. Med. Trop ; Rev. Soc. Bras. Med. Trop;54: e0865-2020, 2021. graf
Artigo em Inglês | LILACS | ID: biblio-1155585

RESUMO

Abstract This report describes a case of multisystem inflammatory syndrome in a child that evolved with a pattern of toxic shock syndrome with coronary artery ectasia and neurological involvement, documented by magnetic resonance imaging, with changes in the corpus callosum and myopathy in the pelvic girdle and paravertebral musculature.


Assuntos
Humanos , Criança , Infecções por Coronavirus , Doenças Musculares/diagnóstico , Síndrome , Imageamento por Ressonância Magnética , Síndrome de Resposta Inflamatória Sistêmica , Betacoronavirus
14.
BMC Pregnancy Childbirth ; 14: 107, 2014 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-24641730

RESUMO

BACKGROUND: Bacterial vaginosis (BV) increases the risk of spontaneous preterm deliveries (PD) in developed countries. Its prevalence varies with ethnicity, socioeconomic conditions and gestational age. Aerobic vaginitis (AV) has also been implicated with spontaneous PD. The present study aimed to estimate the prevalence of asymptomatic BV, the accuracy of vaginal pH level to predict BV and to estimate the risk of spontaneous PD <34 and <37 weeks' gestation of BV and AV. METHODS: Women attending prenatal public services in Rio de Janeiro were screened to select asymptomatic pregnant women, < 20 weeks' gestation, with no indication for elective PD and without risk factors of spontaneous PD. Vaginal smears of women with vaginal pH > = 4.5 were collected to determine the Nugent score; a sample of those smears was also classified according to a modified Donders' score. Primary outcomes were spontaneous PD < 34 and <37 weeks' gestation and abortion. RESULTS: Prevalence of asymptomatic BV was estimated in 28.1% (n = 1699); 42.4% of the smears were collected before 14 weeks' gestation. After an 8-week follow up, nearly 40% of the initially BV positive women became BV negative. The prevalence of BV among white and black women was 28.1% (95% CI: 24.6%-32.0%) and 32.5% (95% CI: 28.2%-37.2%), respectively. The sensitivity of vaginal pH= > 4.5 and = > 5.0 to predict BV status was 100% and 82%, correspondingly; the 5.0 cutoff value doubled the specificity, from 41% to 84%. The incidence of < 37 weeks' spontaneous PDs among BV pregnant women with a pH= > 4.5 was 3.8%. The RR of spontaneous PD < 34 and <37 weeks among BV women with pH > =4.5, as compared with those with intermediate state, were 1.24 and 1.86, respectively (Fisher's exact test, p value = 1; 0.52, respectively, both ns). No spontaneous case of PD or abortion was associated with severe or moderate AV. CONCLUSIONS: A high prevalence of asymptomatic BV was observed without statistically significant difference between black and white women. The RRs of spontaneous PD < 34 and <37 weeks among women with BV, as compared with those with intermediate state were not statistically significant but were consistent with those found in the literature.


Assuntos
Etnicidade , Complicações Infecciosas na Gravidez/etnologia , Nascimento Prematuro/etnologia , Vagina/metabolismo , Vaginite/etnologia , Vaginose Bacteriana/etnologia , Adulto , Bactérias Aeróbias/isolamento & purificação , Brasil/epidemiologia , Feminino , Seguimentos , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/economia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , América do Sul/etnologia , Fatores de Tempo , Vagina/microbiologia , Esfregaço Vaginal , Vaginite/complicações , Vaginite/diagnóstico , Vaginose Bacteriana/complicações , Vaginose Bacteriana/diagnóstico
15.
Rev. eletrônica enferm ; 15(3): 648-655, jul.-set. 2013.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: lil-717949

RESUMO

Este estudo qualitativo teve por objetivo descrever o processo de aquisição de práticas obstétricas hospitalares, pelas enfermeiras obstétricas, frente à implantação do modelo humanizado. Participaram do estudo 11 enfermeiras obstétricas de seis maternidades municipais do Rio de Janeiro/Brasil. Os dados foram coletados por meio de entrevistas, de janeiro a março de 2009, e analisados por meio da análise de conteúdo temática, tendo como base de diálogo os conceitos de Pierre Bourdieu. Os resultados apontaram que as enfermeiras pesquisadas incorporaram novos conhecimentos que foram agregados em seu habitus profissional, gerando práticas que as fizeram romper com a reprodução do modelo biomédico no campo obstétrico. Concluiu-se que muitas enfermeiras obstétricas no processo de implantação da política de humanização do parto e nascimento reconfiguraram sua prática obstétrica de cuidado, centrando-as no estímulo do protagonismo da mulher e no respeito à fisiologia do parto...


The objective of this qualitative study was to describe the practices performed by obstetrical nurses in hospitals, in view of the implementation of the humanized model for birth care. The participants were 11 obstetrical nurses from six municipal maternity hospitals in Rio de Janeiro/Brazil. Data were collected through interviews performed between January and March of 2009, and submitted to thematic content analysis based on the concepts proposed by Pierre Bourdieu. Results showed that the studied nurses incorporated new knowledge that were added to their professional habitus, creating practices that eventually broke with the reproduction of the biomedical model in the field of obstetrics. In conclusion, many obstetrical nurses restructured their obstetrical care practice when implementing the policy of humanized birth care, focusing their practice on encouraging the woman's leading role regarding birth physiology...


Estudio cualitativo que objetivó describir el proceso de adquisición de prácticas obstétricas hospitalarias por parte de las enfermeras obstétricas, ante la implantación del modelo humanizado. Participaron 11 enfermeras obstétricas de seis maternidades municipales de Rio de Janeiro/Brasil. Datos recolectados mediante entrevistas, entre enero y marzo de 2009, analizados según análisis de contenido temático, teniendo como bases de diálogo los conceptos de Pierre Bordieu. Los resultados expresaron que las enfermeras estudiadas incorporaron nuevos conocimientos que fueron agregados a su habitus profesional, generando prácticas que las hicieron romper con la reproducción del modelo biomédico en el campo obstétrico. Se concluyó en que muchas enfermeras obstétricas, en el proceso de implantación de la política de humanización del parto y nacimiento, reconfiguran su práctica obstétrica de cuidado, enfocándolas en el estímulo del protagonismo de la mujer y en el respeto a la fisiología del parto...


Assuntos
Humanos , Feminino , Gravidez , Enfermagem Obstétrica/tendências , Parto Humanizado
16.
Rev. enferm. UERJ ; 19(4): 644-649, out.-dez. 2011. ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: lil-645070

RESUMO

O objetivo deste estudo foi identificar e analisar a produção científica sobre o sono do recém-nascido internado na unidade de terapia intensiva neonatal. Trata-se de pesquisa bibliográfica com dados da Biblioteca Virtual em Saúde e descritores: sono, recém-nascido e unidade de cuidados intensivos neonatal, de 2002 a 2007. Dados dos 11 artigos encontrados no Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Sistema Online de Busca e Análise de Literatura Médica (MEDLINE) foram categorizados nas temáticas: desenvolvimento do recém-nascido e cuidado ao recém-nascido. A primeira correlaciona desenvolvimento com padrão de sono. A segunda relaciona o cuidado à redução do estresse e qualidade do sono. Há ênfase em prevenção de morte súbita e operacionalização do cuidado ao recém-nascido com foco na avaliação pela enfermagem. Há escassa produção nacional e internacional sobre o tema, embora os trabalhos publicados sejam relevantes para a assistência ao recém-nascido.


The purpose of this study was to identify and analyze the scientific production on sleep among newborns admitted to neonatal intensive care units. The literature search used data for 2002 to 2007 in a digital health library (Biblioteca Virtual em Saúde) using the descriptors: sleep, newborn and neonatal intensive care unit. Data from the 11 articles found in the SciELO, Lilacs and MEDLINE data bases were categorized into themes: development of the newborn, and care for the newborn. The former correlates development with sleep patterns. The latter relates care with minimizing stress, and with sleep quality. There is an emphasis on preventing sudden death and on operationalizing care for the newborn with a focus on nursing assessment. Brazilian and international scientific production on the subject is scarce, although the studies published are important to care for the newborn.


El objetivo de este estudio fue identificar y analizar la producción científica sobre el sueño del recién nacido internado en la unidad de terapia intensiva neonatal. Se trata de investigación bibliográfica con datos de la Biblioteca Virtual en Salud y descriptores: sueño, recién nacido y unidad de cuidados intensivos neonatal, de 2002 a 2007. Datos de los 11 artículos encontrados en Scientific Electronic Library Online (SciElo), Literatura Latino-Americana y del Caribe en Ciencias de la Salud (LILACS) y Sistema Online de Búsqueda y Análisis de Literatura Médica (MEDLINE) fueron clasificados en las temáticas: desarrollo del recién nacido y cuidado al recién nacido. La primera relaciona desarrollo con patrón de sueño. La segunda relaciona el cuidado a la reducción del estrés y calidad del sueño. Hay énfasis en prevención de muerte súbita y aplicación del cuidado al recién nacido con foco en la evaluación por la enfermería. Hay escasez de producción nacional e internacional sobre el tema, aunque los trabajos publicados sean relevantes para la asistencia al recién nacido.


Assuntos
Recém-Nascido , Cuidados de Enfermagem/métodos , Enfermagem Neonatal/métodos , Sono , Terapia Intensiva Neonatal/métodos , Bases de Dados Bibliográficas , Comunicação e Divulgação Científica , Pesquisa em Enfermagem , Unidades de Terapia Intensiva
17.
Trials ; 12: 239, 2011 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-22059409

RESUMO

BACKGROUND: Bacterial vaginosis increases the risk of spontaneous preterm delivery at less than 34 weeks of gestation. OBJECTIVE: The purpose of this study was to evaluate the efficacy of the early administration of selected lactobacilli strains (probiotics) to pregnant women with asymptomatic bacterial vaginosis/intermediate-degree infections to prevent spontaneous premature delivery and associated neonatal morbidity. METHODS/DESIGN: Asymptomatic pregnant women at less than 20 weeks of gestation, with no indication of elective preterm delivery, with a vaginal pH ≥ 4.5 and Nugent score > 3 were randomly assigned to the placebo or intervention group (oral administration of selected lactobacilli up to the 24th to 26th week of gestation). The randomisation was stratified for the history of premature delivery (HPD) and blocked. The allocation was concealed, and the participating health professionals and patients were blinded. The primary outcome was preterm delivery (<34 to <32 weeks), and the secondary outcomes were associated neonatal complications. RESULTS: In total, 4,204 pregnant women were screened; 320 and 324 individuals were respectively randomly assigned to the placebo and intervention groups, and 62% finished the trial. None of the randomised patients were lost to follow-up. For the non-HPD stratum, the intent-to-treat relative risks of spontaneous premature birth at < 34 and < 37 weeks' gestation were 0.33 (0.03, 3.16) and 0.49 (0.17, 1.44), respectively, and they were non-significant (ns) with p = 0.31 and 0.14. The corresponding actual treatment figures were zero and 0.32 (0.09, 1.19), which were ns with p = 0.12 and 0.06. The intent-to-treat relative risk of spontaneous premature birth at < 37 weeks of gestation for the trial as a whole, including HPD and non-HPD participants, was 0.69 (0.26, 1.78), p = 0.30 (ns). The neonatal complications under evaluation occurred in only one infant (< 34 weeks; placebo group) who presented with respiratory distress syndrome and suspected early neonatal sepsis. The recorded adverse events were minor and relatively non-specific. CONCLUSIONS: The efficacy of the tested probiotics to prevent preterm delivery among women without a history of preterm delivery was not determined because the study sample was insufficient to estimate statistically significant intent-to-treat effects; additional studies are needed to evaluate this intervention among these women. TRIAL REGISTRATION: Trial registration at NIH register: NCT00303082. Sources of funding: the Brazilian Health Ministry and the State of Rio de Janeiro Research Foundation.


Assuntos
Nascimento Prematuro/prevenção & controle , Probióticos/uso terapêutico , Vaginose Bacteriana/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Gravidez
18.
J Alzheimers Dis ; 27(4): 897-907, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21908911

RESUMO

We sought to identify cognitive phenotypes for family/genetic studies of successful cognitive aging (SCA; maintaining intact cognitive functioning while living to late old age). We administered a battery of neuropsychological tests to nondemented nonagenarians (n = 65; mean age = 93.4 ± 3.0) and their offspring (n = 188; mean age = 66.4 ± 5.0) from the Central Valley of Costa Rica. After covarying for age, gender, and years of education, as necessary, heritability was calculated for cognitive functions at three pre-defined levels of complexity: specific neuropsychological functions (e.g., delayed recall, sequencing), three higher level cognitive domains (memory, executive functions, attention), and an overall neuropsychological summary. The highest heritability was for delayed recall (h² = 0.74, se = 0.14, p < 0.0001) but significant heritabilities involving memory were also observed for immediate recall (h² = 0.50), memory as a cognitive domain (h² = 0.53), and the overall neuropsychological summary (h² = 0.42). Heritabilities for sequencing (h² = 0.42), fluency (h² = 0.39), abstraction (h² = 0.36), and the executive functions cognitive domain (h² = 0.35) were also significant. In contrast, the attention domain and memory recognition were not significantly heritable in these families. Among the heritable specific cognitive functions, a strong pleiotropic effect (i.e., evidence that these may be influenced by the same gene or set of genes) for delayed and immediate recall was identified (bivariate statistic = 0.934, p < 0.0001) and more modest but significant effects were found for four additional bivariate relationships. The results support the heritability of good cognitive function in old age and the utilization of several levels of phenotypes, and they suggest that several measures involving memory may be especially useful for family/genetic studies of SCA.


Assuntos
Envelhecimento/genética , Transtornos Cognitivos/genética , Saúde da Família , Transtornos da Memória/genética , Reconhecimento Psicológico/fisiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atenção/fisiologia , Transtornos Cognitivos/epidemiologia , Costa Rica/epidemiologia , Função Executiva/fisiologia , Feminino , Ligação Genética , Humanos , Masculino , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Irmãos , Aprendizagem Verbal
19.
Cienc. enferm ; 16(2): 115-125, ago. 2010. ilus
Artigo em Português | LILACS | ID: lil-577095

RESUMO

Pesquisa descritiva, abordagem qualitativa baseada nos pressupostos do Interacionismo Simbólico e da Grounded Theory, estuda a gravidez como período de adaptações físicas e emocionais. Objetivou-se identificar o significado das transformações do período gestacional, sob o ponto de vista da gestante, que influenciam em sua identificação como mãe. Os dados foram obtidos em 2005, com entrevistas semi-estruturadas, no pré-natal de um Centro Municipal de Saúde, do Rio de Janeiro. A análise comparativa constante permitiu a construção de duas categorias cuja integração em suas diferentes dimensões possibilitou identificar a categoria central: vivenciando repercussões e transformações de uma gestação . Esta representa um processo ativo de busca pela identidade materna. Os resultados mostraram que transformações gestacionais repercutem diretamente na construção feminina da maternidade e na identidade da mulher como mãe.


This is a descriptive and qualitative study based on the principles of Symbolic Interactionism and Grounded Theory. It approaches the pregnancy as a life period of physical and emotional adaptations. It aimed at identify the meaning of the pregnancy transformations, from the pregnant's point of view, and its influences in woman's identification as mother. Data were obtained in 2005, with semi-structured interviews, in the prenatal service of a Municipal Health Center in Rio de Janeiro-Brazil. The constant comparative analysis allowed the construction of two categories whose integration in their different dimensions made possible to identify the central category: living repercussions and transformations of a pregnancy. This represents an active process of searching for the maternal identity. The results showed that pregnancy's transformations influences directly in the feminine construction of the maternity and in the woman's identity as mother.


Éste es un estudio descriptivo y cualitativo basado en los principios del Interaccionismo Simbólico y de la Grounded Theory. Es acerca del embarazo como un período de vida de adaptaciones físicas y emocionales, cuyo objetivo es identificar el significado de las transformaciones del embarazo, desde el punto de vista de la embarazada, y sus influencias en la identificación de esta mujer como madre. Se obtuvieron los datos en 2005, a través de entrevistas semiestructuradas, en un servicio prenatal de un Centro Municipal de Salud en Río de Janeiro-Brasil. El análisis comparativo constante permitió la construcción de dos categorías cuya integración en sus dimensiones diferentes hizo posible identificar la categoría central: la vivencia de las repercusiones y transformaciones de un embarazo. Esto representa un proceso activo de buscar la identidad materna. Los resultados mostraron las influencias de las transformaciones de ese embarazo directamente en la construcción femenina de la maternidad y en la identidad de la mujer como madre.


Assuntos
Humanos , Feminino , Gravidez , Gravidez/fisiologia , Gravidez/psicologia , Gestantes , Saúde da Mulher , Brasil
20.
Reprod Health ; 7: 14, 2010 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-20591191

RESUMO

BACKGROUND: Spontaneous preterm deliveries that occur before the 34th week of gestation, and particularly before the 32nd week of gestation, have been strongly associated to intrauterine infection, ascending from vagina, and represent the largest portion of neonatal deaths and neurological problems. Bacterial vaginosis, characterized by a diminished or absent flora of lactobacilli and increased colonization of several anaerobic or facultative microorganisms, increases two times the risk of preterm delivery before the 34th week. Trials of antibiotics failed to show efficacy and effectiveness against spontaneous preterm birth related to bacterial vaginosis. Some studies indicate benefit from selected probiotics to treat genitourinary infections, including bacterial vaginosis. OBJECTIVE: The purpose of this study is to evaluate the effectiveness of the early administration of selected probiotics to pregnant women with asymptomatic bacterial vaginosis/intermediate degree infection to reduce the occurrence of spontaneous preterm delivery and related neonatal mortality and morbidity. METHODS/DESIGN: Women attending public prenatal care services in Rio de Janeiro will be screened to select asymptomatic pregnant women, less than 20 weeks' gestation, with no indication of elective preterm delivery. Those with vaginal pH > = 4.5 and a Nugent score between 4 and 10 (intermediate degree infection or bacterial vaginosis) will be randomized to either the placebo or the intervention group, after written informed consent. Intervention consists in the use of probiotics, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, 2 capsules a day, each capsule containing more than one million bacilli of each strain, for 6-12 weeks, up to the 24th-25th wk of gestation. Ancillary analyses include quantification of selected cervicovaginal cytokines and genotyping of selected polymorphisms. The randomization process is stratified for history of preterm delivery and blocked. Allocation concealment was designed as well as blinding of women, caregivers and outcome evaluators. The study will be supervised by an independent monitoring committee. Outcomes under study are preterm delivery (< 34- < 32 weeks of gestation) and associated neonatal complications: early neonatal sepsis, bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, and prematurity-related retinopathy; definitions were adapted from those recommended by the 2002 version of the Vermont-Oxford Network. Trial registration at NIH register: NCT00303082.

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