Search

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. RESUMO CONTEXTO E OBJETIVO: Esta revisão sistemática comparou o reiki e a oração ao uso de medicamentos, a fim de aliviar a dor durante a internação para cesariana, visto que há um aumento na popularidade da medicina integrativa e cura espiritual. Esta revisão teve como objetivo avaliar se o reiki ou oração são eficazes no alívio da dor durante a cesariana. TIPO DE ESTUDO E LOCAL: Revisão sistemática com metanálise realizada na Faculdade de Medicina de Botucatu UNESP, São Paulo, Brasil. MÉTODOS: As seguintes bases de dados foram pesquisadas até março de 2016: MEDLINE, Embase, LILACS e CENTRAL. Nesse sentido, foram incluídos ensaios clínicos randomizados publicados em inglês e português. Dois revisores rastrearam independentemente artigos elegíveis, extraíram dados e avaliaram o risco de viés. A tabela GRADE foi realizada para avaliar o risco de viés. RESULTADOS: Evidências com alto índice de viés encontraram uma diminuição estatisticamente significativa na redução da dor (diferença média = -1,68; intervalo de confiança de 95%: -1,92 a -1,43; P < 0,00001; I2 = 92%), com o uso de reiki e oração comparado com o grupo protocolar. Além disso, não houve diferença estatisticamente significativa na frequência cardíaca, pressão arterial sistólica e diastólica. CONCLUSÃO: Evidência com alto risco de viés sugeriu que reiki e meditação oração podem ser associadas com a redução da dor.

BackgroundTrials have examined on the benefits of vitamin D supplementation in pregnant women.ObjectiveThis 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.MethodWe 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).ResultsThe 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.ConclusionWe 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.

Made available in DSpace on 2018-12-11T17:21:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-07-01 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: MED-LINE (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. Nursing Department Botucatu Medical School UNESP–Univ Estadual Paulista Institute of Science and Technology Department of Biosciences and Oral Diagnosis UNESP Nursing Department of Gynecology and Obstetrics Universidade Estadual Paulista (Unesp) Botucatu Medical School UNESP Municipal Authority of Botucatu Minas Gerais Medical School UFMG -Univ Federal de Minas Gerais Department of Collective Health Botucatu Medical School Nursing Department Botucatu Medical School UNESP–Univ Estadual Paulista Institute of Science and Technology Department of Biosciences and Oral Diagnosis UNESP Nursing Department of Gynecology and Obstetrics Universidade Estadual Paulista (Unesp) Botucatu Medical School UNESP Department of Collective Health Botucatu Medical School

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:05:57Z No. of bitstreams: 1 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) Made available in DSpace on 2013-08-22T19:05:57Z (GMT). No. of bitstreams: 1 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) Previous issue date: 2012-01-01 Made available in DSpace on 2013-09-30T20:09:58Z (GMT). No. of bitstreams: 2 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) S1516-31802012000100004.pdf.txt: 48569 bytes, checksum: 8b37e8a01344cf5d7ace0fd179e97fc4 (MD5) Previous issue date: 2012-01-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:35:12Z No. of bitstreams: 2 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) S1516-31802012000100004.pdf.txt: 48569 bytes, checksum: 8b37e8a01344cf5d7ace0fd179e97fc4 (MD5) Made available in DSpace on 2014-05-20T13:35:12Z (GMT). No. of bitstreams: 2 S1516-31802012000100004.pdf: 313562 bytes, checksum: b0dd271caaf0e7331b9e765ca84b4ea0 (MD5) S1516-31802012000100004.pdf.txt: 48569 bytes, checksum: 8b37e8a01344cf5d7ace0fd179e97fc4 (MD5) Previous issue date: 2012-01-01 CONTEXTO E OBJETIVO: Gestações complicadas pelo diabetes estão associadas com aumento de complicações maternas e neonatais. Os custos hospitalares aumentam de acordo com a assistência prestada. O objetivo foi calcular o custo-benefício e a taxa de rentabilidade social da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes ou com hiperglicemia leve. DESENHO do ESTUDO: Estudo prospectivo, observacional, quantitativo, realizado em hospital universitário, sendo incluídas todas as gestantes com diabetes pregestacional e gestacional ou com hiperglicemia leve que não desenvolveram intercorrências clínicas na gestação e que tiveram parto no Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (HC-FMB-Unesp). MÉTODOS: Trinta gestantes tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta e insulina foram abordadas com hospitalizações curtas e frequentes. Foram obtidos custos diretos (pessoal, material e exames) e indiretos (despesas gerais) a partir de dados contidos no prontuário e no sistema de custo por absorção do hospital e posteriormente calculado o custo-benefício. RESULTADOS: O sucesso do tratamento das gestantes diabéticas evitou o gasto de US$ 1.517,97 e US$ 1.127,43 para pacientes hospitalizadas e ambulatoriais, respectivamente. O custo-benefício da atenção hospitalizada foi US$ 143.719,16 e ambulatorial, US$ 253.267,22, com rentabilidade social 1,87 e 5,35 respectivamente. CONCLUSÃO: A análise árvore de decisão confirma que o sucesso dos tratamentos elimina custos no hospital. A relação custo-benefício indicou que o tratamento ambulatorial é economicamente mais vantajoso do que a hospitalização. A rentabilidade social de ambos os tratamentos foi maior que 1, indicando que ambos os tipos de atendimento à gestante diabética têm benefício positivo. 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. Univ Estadual Paulista Unesp, FMB, HC, Dept Gynecol & Obstet, Botucatu, SP, Brazil Univ Estadual Paulista Unesp, FMB, HC, Dept Nursing, Botucatu, SP, Brazil Univ Estadual Paulista Unesp, Postgrad Programs, Botucatu, SP, Brazil Univ Estadual Paulista Unesp, FMB, HC, Dept Gynecol & Obstet, Botucatu, SP, Brazil

Background: Diabetes mellitus (DM) is a public health concern spread worldwide. Maternal diabetes in pregnancy increases risk of adverse perinatal and maternal outcomes; therefore; affecting the women´s quality of life (QOL). Objective: To evaluate quality of life in pregnant women with diabetes mellitus, gestational diabetes or mild gestational hyperglycemia. Study Design: This is a prospective and longitudinal study. The sample comprised 105 pregnant women, i.e. 66 Hyperglycemic (HG) and 39 Normoglycemic (NG). The validated WHOQOL–BREF/ QUALITY of LIFE ASSESSMENT questionnaire was applied at the first prenatal appointment or at time of disease diagnosis; and re-applied at delivery admission or at 36-37 weeks’ gestation. Results: Most pregnant women considered good QOL at early pregnancy, but not at late pregnancy. In general, they were satisfied with their quality of life. NG pregnant women were more satisfied than their HG counterparts. At the onset of the gestational period the HG group obtained lower scores in the physical domain than the NG group. At the end of the gestational period, the scores on physical, psychological and environmental domains were significant lower in pregnant women with diabetes or hyperglycemia. Conclusion: The study demonstrated that pregnant women with diabetes or hyperglycemia were compromised in certain aspects of quality of life. Keywords: Pregnancy, Diabetes mellitus, hyperglycemia, life quality, outpatient treatment, hospital

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.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.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.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.

This study aimed at identifying the hospitalization costs of pregnant women with Diabetes Mellitus (DM) at a University Hospital. It is an observational, quantitative study with descriptive data analysis. The direct and indirect costs available in the institution were identified in order to determine the hospitalization costs for patients diagnosed with DM during pregnancy and childbirth. By means of descriptive statistics, it was observed that 63.46% of the patients had caesarean delivery; the mean total cost was R$ 362.93 (U$ 218.10)/hospitalization during pregnancy, R$ 2,642.65 (U$ 1,588.13)/hospitalization for caesarean delivery, and R$ 2.319.77 (U$ 1,394.09)/hospitalization for vaginal delivery. It was concluded that the analysis of hospitalization costs for patients with DM is of utmost importance, since they are high- complexity hospitalizations that require a large number of interventions, increasing thus the service costs.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:28Z No. of bitstreams: 1 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) Made available in DSpace on 2013-08-22T19:03:28Z (GMT). No. of bitstreams: 1 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) Previous issue date: 2012-04-01 Made available in DSpace on 2013-09-30T18:21:05Z (GMT). No. of bitstreams: 2 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) S0034-89102012000200016.pdf.txt: 35938 bytes, checksum: 14c12bbfb6c7e4402af90562c4773ef2 (MD5) Previous issue date: 2012-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:13Z No. of bitstreams: 2 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) S0034-89102012000200016.pdf.txt: 35938 bytes, checksum: 14c12bbfb6c7e4402af90562c4773ef2 (MD5) Made available in DSpace on 2014-05-20T13:33:13Z (GMT). No. of bitstreams: 2 S0034-89102012000200016.pdf: 376867 bytes, checksum: ae5c8727e79d911033714c6ede9b18cd (MD5) S0034-89102012000200016.pdf.txt: 35938 bytes, checksum: 14c12bbfb6c7e4402af90562c4773ef2 (MD5) Previous issue date: 2012-04-01 OBJETIVO: Comparar custos de hospitalização e de atenção ambulatorial em gestantes/parturientes diabéticas e com hiperglicemia leve. MÉTODOS: Estudo observacional, prospectivo, quantitativo descritivo realizado em centro de diabete perinatal em Botucatu, SP, entre 2007 e 2008. Foram estimados os custos por absorção diretos e indiretos disponíveis na instituição e os custos específicos para a doença (medicamentos e exames). As 30 gestantes diabéticas tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta mais insulina foram hospitalizadas. RESULTADOS: O custo da doença diabete (para a assistência pré-natal e parto) foi de US$ 3,311.84 para as gestantes hospitalizadas e de US$ 1,366.04 para as acompanhadas em ambulatório. CONCLUSÕES: Os custos diretos e indiretos e o custo total da assistência pré-natal foram mais elevados nas gestantes diabéticas hospitalizadas enquanto os custos da assistência ao parto e hospitalização para parto e puerpério foram semelhantes. Os custos da assistência pré-natal como no parto/puerpério foram superiores aos valores pagos pelo Sistema Único de Saúde. 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. OBJETIVO: Comparar costos de hospitalización y de atención por ambulatorio en gestantes/parturientas diabéticas y con hiperglicemia leve. MÉTODOS: Estudio observacional, prospectivo, cuantitativo descriptivo realizado en centro de diabetes perinatal en Botucatu, Sureste de Brasil, entre 2007 y 2008. Se estimaron los costos por absorción directos e indirectos disponibles en la institución y los costos específicos para la enfermedad (medicamentos y exámenes). Las 30 gestantes diabéticas tratadas con dieta fueron acompañadas en ambulatorio y 20 tratadas con dieta más insulina fueron hospitalizadas. RESULTADOS: El costo de la enfermedad diabetes (para asistencia prenatal y parto) fue de US$ 3,311.84 para las gestantes hospitalizadas y de US$ 1,366.04 para las acompañadas en ambulatorio. CONCLUSIONES: Los costos directos e indirectos y el costo total de la asistencia prenatal fueron más elevados en las gestantes diabéticas hospitalizadas mientras que los costos de la asistencia al parto y hospitalización para parto y puerperio fueron semejantes. Los costos de la asistencia prenatal como en el parto/puerperio fueron superiores a los valores pagados por el Sistema Único de Salud. Univ Estadual Paulista Julio de Mesquita Filho Un, Grad Program Gynecol Obstet & Mastol, Botucatu Med Sch, Botucatu, SP, Brazil UNESP, Botucatu Med Sch, Dept Nursing, Botucatu, SP, Brazil Unesp Botucatu Medical School Department of Obstetrics and Gynecology Univ Estadual Paulista Julio de Mesquita Filho Un, Grad Program Gynecol Obstet & Mastol, Botucatu Med Sch, Botucatu, SP, Brazil UNESP, Botucatu Med Sch, Dept Nursing, Botucatu, SP, Brazil Unesp Botucatu Medical School Department of Obstetrics and Gynecology