Background: Breastfeeding protects against a variety of adverse health outcomes for mothers and babies. Global best practices, known as the Baby-Friendly Hospital Initiative (BFHI), have been developed to support the initiation and exclusivity of breastfeeding during the post-delivery hospital stay. The aims of this study were to explore the literature related to the impact of the BFHI on breastfeeding disparities in the U.S.; compare the impact of exposure to these best practices on exclusive breastfeeding rates in Appalachian and non-Appalachian hospitals; and to understand knowledge, perceptions, and barriers to breastfeeding of postpartum mothers receiving care in a Northeast Tennessee OB/GYN clinic and regional International Board Certified Lactation Consultants’ (IBCLCs®) knowledge, perceptions, and barriers to implementation of the BFHI. Methods: A scoping review was completed to explore literature related to exposure to the BFHI and breastfeeding disparities using the Levac, Colquhoun, and O’Brien methodology. A linear regression analysis of Maternity Practices in Infant Nutrition and Care (mPINC) breastfeeding best practice scores and breastfeeding rates at discharge was conducted comparing this relationship in Appalachian and non-Appalachian hospitals. Finally, a qualitative study was conducted using semi-structured interviews and thematic analysis to gather information from postpartum mothers and regional IBCLCs®. Results: The BFHI has been found to reduce both geographic and racial/ethnic disparities in the U.S., but there are limited studies examining this topic. While there was a significant negative relationship between Appalachian hospitals and exclusive breastfeeding rates at discharge (p=0.0003), there was no significant difference in the relationship between total mPINC scores and exclusive breastfeeding rates at hospital discharge between the two designations (0.4539). Furthermore, both postpartum patients and regional IBCLCs® reported that support, education, and self-efficacy were all necessary to assist mothers on their infant feeding journey. Implications: These findings highlight the need for studies examining the impact of the BFHI on breastfeeding disparities. Research also needs to be conducted to better understand breastfeeding rates in economically distressed, rural areas of the country. Ultimately, risk-stratified interventions supporting the specific needs of a population should be identified or developed to support and empower postpartum mothers to achieve their infant feeding goals.

This study explores the relationship between ideals of motherhood and heterosexual normativity, from the perspective of women at the margins of these discourses. The title, In the shadow of Motherhood, illustrates the overriding power of the image of motherhood to marginalise alternative experiences. The concept of motherhood, like that of Family, has traditionally signalled the reproduction of the normative; it does not usually encompass the critical scrutiny that would allow for diverse experiences of mothering. Theoretically, the study is located within the fields of feminist sociology and inclusive family studies in productive dialogue with queer notions of gender and sexuality. Methodologically, it is inspired by narrative analysis and consists of in-depth interviews with eight lesbian, bisexual and heterosexual women grappling with different experiences of motherhood and mothering practices. Some of them identify as mothers while others do not, but by not being biogenetic mothers within a heterosexual relationship they share the position of being outside of what is often considered normal, natural and desirable. The analysis reveals a considerable variation in the positions, experiences and identities of the participants, particularly in regards to changes over time, which cannot be reduced to binary categories such as heterosexual/lesbian, biological/non-biological, mother/childless or voluntary/involuntary childlessness. The analysis also exposes a deep tension between ideologies of motherhood and lived experiences of care practices. Furthermore, from the perspective of the participants, the boundaries between inclusion and exclusion reinforce and challenge each other, creating spaces of both individual and collective resistance. The study illuminates the need to shift the location of these experiences from the margins to the centre not only in sociological research of family and gender, but also within feminist sociology.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A pesquisa tem como tema a prática de cuidado no matriciamento em saúde mental na Estratégia da Saúde da Família. Matriciamento é uma metodologia de prática de cuidado em saúde, constituído por uma equipe de profissionais especialistas, que possui o objetivo de oferecer apoio e retaguarda à equipe de profissionais da Estratégia Saúde da Família. A hipótese é de que a prática de matriciamento em saúde mental é um dispositivo de transformação do imaginário social sobre a loucura. Trata-se de uma pesquisa de abordagem psicossocial de referencial teórico na sociologia e na antropologia para discutir os conceitos de cultura, imaginário social, práticas de cuidado e rede social, por entender que a prática de cuidado no matriciamento em saúde mental opera em rede e produz transformação no imaginário social sobre a loucura. O estudo tem, inicialmente, como base metodológica a sociologia para a análise documental da Lei 10.216/2001 Reforma Psiquiátrica brasileira - e da Portaria 154/2008 Núcleo de Apoio à Saúde da Família NASF. Em seguida, apoiada pela antropologia, a pesquisa utiliza o método etnográfico para a realização de entrevista com quatro profissionais matriciadores, tendo a análise do discurso como caminho para discutir e problematizar os dados coletados. Conclui-se, então, que o matriciamento é um dispositivo de rede e produção de cuidado que pode favorecer a transformação do imaginário social sobre a loucura. Porém, é de fundamental importância que a rede tenha funcionalidade para que isto possa ocorrer de fato, pois o matriciamento é um dispositivo de rede e de cuidado em saúde. / The main topic on the present research are the care practices in the matrix-based strategies in mental health contemplated on the Family Health Strategy (Estratégia da Saúde da Família). The Matrix-based strategies are a care practice methodology, constituted by a team of specialists, that offer back-up and support to the professionals from the Family Health Strategy (Estratégia da Saúde da Familia). The study is based on the hypothesis that the matrix-based strategies in mental health are a transformation devise for the social imaginary about madness. This is a research with a psycho-social approach, with a sociological and anthropological theoretical framework, and will analyze the concepts of culture, social imaginary, care practice and social network. Its understood that care practices in matrixbased strategies in mental health operate in networks and can create a transformation in the social imaginary about madness. Initially, this inquiry is based on a sociological theoretical framework in order to make a documental analysis of the Law number 10.216/2001 on Brazilian Psychiatric Reform (Reforma Psiquiátrica brasileira) and also the Portaria 154/2008 Family Health Support Center (Núcleo de Apoio à Saúde da Família NASF). Afterwards, an anthropological theoretical framework is used to develop an interview based on the ethnographic method. Four Professional developers of matrix-based strategies were interviewed, and the collected information was speech analyzed. The conclusion is that the matrix-based strategies are a care production and a networking devise that can favor the social imaginary transformation about madness, where its crucial for the network to be functional in order to allow the transformation, in fact, to happen.

p. 1-194 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-25T18:28:34Z No. of bitstreams: 1 4444444.pdf: 720577 bytes, checksum: 185847fe543333b10188b2111cec01e3 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:01:14Z (GMT) No. of bitstreams: 1 4444444.pdf: 720577 bytes, checksum: 185847fe543333b10188b2111cec01e3 (MD5) / Made available in DSpace on 2013-05-04T17:01:14Z (GMT). No. of bitstreams: 1 4444444.pdf: 720577 bytes, checksum: 185847fe543333b10188b2111cec01e3 (MD5) Previous issue date: 2011 / A tradução da integralidade, enquanto diretriz constitucional e princípio do SUS, em práticas concretas nos serviços de saúde tem sido problematizada por diversos autores, embora sejam poucos os estudos empíricos que buscaram avaliar sistematicamente intervenções direcionadas a sua operacionalização. A presente investigação teve como objetivos: estimar o grau de implantação da integralidade em diferentes equipes de saúde da família de um município do Estado da Bahia, considerado em estágio avançado do processo de descentralização e como exemplar no que se refere à implementação do Programa de Saúde da Família, buscando analisar possíveis obstáculos e facilidades à implementação dessa diretriz relacionados às características dos agentes das práticas do PSF. Foi realizado um estudo de caso único que teve como unidade de análise as equipes de saúde da família. A coleta de dados contou com a análise documental de relatórios de gestão, planos e programas; entrevistas semiestruturadas com informantes-chave (profissionais das equipes e técnicos/coordenadores responsáveis pelo PSF) e usuários dos serviços a partir de um roteiro de entrevistas prévio abrangendo as dimensões analisadas, ao lado da observação sistemática do processo de trabalho das equipes. Para estimar o grau de implantação da integralidade nas unidades de saúde da família trabalhou-se com cinco dimensões: acolhimento, longitudinalidade, coordenação da atenção, oferta de ações e continuidade da atenção. Os resultados evidenciaram equipes com grau de implantação intermediário e avançado da integralidade. Observou-se que a gestão municipal de saúde criou condições para o desenvolvimento da integralidade no âmbito das equipes de saúde da família, no entanto, as diferenças encontradas no grau de implantação entre as mesmas estiveram relacionadas à determinadas características dos agentes das práticas, tais como formação especializada em saúde pública e experiência profissional anterior em gestão. Foram discutidas as implicações da insuficiência da operacionalização da diretriz da integralidade da atenção principalmente no que diz respeito à organização dos serviços e das práticas dos profissionais de saúde identificando alguns dos obstáculos e possibilidades para o desenvolvimento de práticas integrais de saúde relacionados à posição ocupada pelos agentes das práticas no espaço da estratégia da Saúde da Família. A melhor delimitação e elaboração do conceito bem como a ampliação do consenso a seu respeito, poderá facilitar a sua expressão em práticas que consolidem a implementação de serviços/sistemas de saúde mais próximos de uma atenção integral. / Salvador

Made available in DSpace on 2016-12-23T13:46:58Z (GMT). No. of bitstreams: 1 Gilza da Silva.pdf: 2294547 bytes, checksum: beb458e06ac77d9aabb22e22a6dcd2fe (MD5) Previous issue date: 2013-04-26 / As Unidades de Saúde da Família (USF) constituem um espaço privilegiado para o cuidado integral em saúde, entendido como produto das relações entre pessoas, uma ação com efeitos e repercussões de interações positivas entre usuários, profissionais e instituições, que são traduzidas em atitudes como tratamento digno e respeitoso, acolhimento e vínculo. O cuidado em saúde não é apenas um nível de atenção do sistema de saúde ou um procedimento técnico, mas uma ação integral que tem significados e sentidos voltados para compreensão da saúde como direito de ser. Com esse entendimento, realizamos esta pesquisa com o objetivo de analisar as práticas de cuidado integral em saúde, efetivadas nas USF da Região de Maruípe, no município de Vitória ES. Demos ênfase às ações voltadas às pessoas com sofrimento mental. Utilizamos aqui o termo sofrimento mental para abarcar o conjunto de males que acometem as pessoas, incluindo as angústias, os lutos, os efeitos da violência cotidiana, as ansiedades e o sofrimento social, além da esquizofrenia e a depressão. Esta pesquisa possui cunho exploratório, descritivo e é de abordagem qualitativa. A coleta de dados foi realizada em três etapas. Foram realizadas seis sessões de grupo focal com objetivo de investigar a presença ou não de práticas de cuidado integral em saúde, voltadas às pessoas com sofrimento mental. Duas ações sistemáticas foram localizadas e observadas durante dois meses. Concomitante à observação, realizaram-se as entrevistas semiestruturadas com os profissionais responsáveis por essas práticas e, a partir da análise dos dados, ressaltamos os limites para o seu desenvolvimento. Um desses é a desvalorização dessas práticas por parte dos profissionais. Enfatizamos a importância da rede de atenção à saúde mental para a construção do cuidado integral, através dos dispositivos do acolhimento, da escuta e da responsabilização / The Family Health Units (FHU) constitute a space privileged to comprehensive health care, understood as a product of the relationships between people, an action with effects and consequences of positive interactions among users, professionals and institutions, which are translated into attitudes like dignified and respectful treatment, care and bonding. Health care is not only a level of attention from the health care system or a technical procedure, but an action that has full meanings and feelings directed towards the understanding of health as a right to be. With this understanding, we conducted this research with the objective of analyzing the practices of comprehensive health care, the effect of USF Maruípe Region, the city of Vitória - ES. We emphasized the actions people with mental distress. We use here the term mental suffering to encompass the set of evils that afflict people, including anguish, the grief, the effects of everyday violence, anxiety and social distress, besides schizophrenia and depression. This research has an exploratory, descriptive and qualitative approach is. Data collection was performed in three steps. Were conducted six focus group sessions in order to investigate the presence or absence of practices comprehensive health care, aimed at people with mental distress. Two systematic actions were located and observed for two months. Concomitant with the observation, there were semi-structured interviews with professionals responsible for these practices, and from the data analysis, we emphasize the limits to its development. One of these is the devaluation of these practices by professionals. We emphasize the importance of the network of mental health care for the construction of comprehensive care, through the devices of welcoming, listening and accountability

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A pesquisa tem como tema a prática de cuidado no matriciamento em saúde mental na Estratégia da Saúde da Família. Matriciamento é uma metodologia de prática de cuidado em saúde, constituído por uma equipe de profissionais especialistas, que possui o objetivo de oferecer apoio e retaguarda à equipe de profissionais da Estratégia Saúde da Família. A hipótese é de que a prática de matriciamento em saúde mental é um dispositivo de transformação do imaginário social sobre a loucura. Trata-se de uma pesquisa de abordagem psicossocial de referencial teórico na sociologia e na antropologia para discutir os conceitos de cultura, imaginário social, práticas de cuidado e rede social, por entender que a prática de cuidado no matriciamento em saúde mental opera em rede e produz transformação no imaginário social sobre a loucura. O estudo tem, inicialmente, como base metodológica a sociologia para a análise documental da Lei 10.216/2001 Reforma Psiquiátrica brasileira - e da Portaria 154/2008 Núcleo de Apoio à Saúde da Família NASF. Em seguida, apoiada pela antropologia, a pesquisa utiliza o método etnográfico para a realização de entrevista com quatro profissionais matriciadores, tendo a análise do discurso como caminho para discutir e problematizar os dados coletados. Conclui-se, então, que o matriciamento é um dispositivo de rede e produção de cuidado que pode favorecer a transformação do imaginário social sobre a loucura. Porém, é de fundamental importância que a rede tenha funcionalidade para que isto possa ocorrer de fato, pois o matriciamento é um dispositivo de rede e de cuidado em saúde. / The main topic on the present research are the care practices in the matrix-based strategies in mental health contemplated on the Family Health Strategy (Estratégia da Saúde da Família). The Matrix-based strategies are a care practice methodology, constituted by a team of specialists, that offer back-up and support to the professionals from the Family Health Strategy (Estratégia da Saúde da Familia). The study is based on the hypothesis that the matrix-based strategies in mental health are a transformation devise for the social imaginary about madness. This is a research with a psycho-social approach, with a sociological and anthropological theoretical framework, and will analyze the concepts of culture, social imaginary, care practice and social network. Its understood that care practices in matrixbased strategies in mental health operate in networks and can create a transformation in the social imaginary about madness. Initially, this inquiry is based on a sociological theoretical framework in order to make a documental analysis of the Law number 10.216/2001 on Brazilian Psychiatric Reform (Reforma Psiquiátrica brasileira) and also the Portaria 154/2008 Family Health Support Center (Núcleo de Apoio à Saúde da Família NASF). Afterwards, an anthropological theoretical framework is used to develop an interview based on the ethnographic method. Four Professional developers of matrix-based strategies were interviewed, and the collected information was speech analyzed. The conclusion is that the matrix-based strategies are a care production and a networking devise that can favor the social imaginary transformation about madness, where its crucial for the network to be functional in order to allow the transformation, in fact, to happen.

Made available in DSpace on 2015-05-14T13:16:10Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1884699 bytes, checksum: 828286627892b1385e26da42a289a7a0 (MD5) Previous issue date: 2012-03-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The response to the emergence of Aids in Brazil potentiated several actions in the health services, so as to ensure quality care, early diagnosis and safe and effective treatment to the population. So, as soon as the HPS (Health Public System) went on to give attention to the needs brought about by the demands of STD/Aids, being the Basic Care (BC), strategically, the largest space for the implementation of a policy of prevention and care of these, since it is the user's preferred input port on the system. In this sense, this study aimed to investigate the care and prevention care and prevention about STD/Aids in Family Health Units (FHU), from the beliefs and practices of the professionals. From a stratified sampling for convenience, have been selected 19 FHU, located in the city of Joao Pessoa-PB, attending a professional at FHU, with ages ranging from 23 to 65 years (M=40; SD=10,63), being only one male. We used three instruments that complemented: structured questionnaire, screenplay submissions and semi structured interview. The data of the questionnaire and of the screenplay were analyzed through descriptive statistics, while the interviews were transcribed and then held a thematic category analysis. From quantitative data, it was found that 11 FHU perform meet the STD from a syndromic approach, although they deal with that treatment is done in specialized services, most of the STD. On the diagnosis, no FHU offers anti-HIV, VDRL tests and serology for Hepatitis B and C. About the availability of male condom, 18 FHU said always have it available to the population, being the free distribution in 12 of them. The populations considered most vulnerable to STD/Aids were women and adolescents/young, although in some USF, prevention activities with them. External activities of prevention were referred by 13 FHU, being the school the most quoted (11 FHU). It was noted that in 9 FHU condoms were available at the reception desk; only in a unit had educational brochures distribution and in 4 had this briefs posters theme. As for qualitative data, the speeches of professionals pointed to 2 thematic classes: 1) HIV infection (Categories: Contagion and Individual HIV seropositivity); and 2) Perceptions and practices in the workplace (Categories: Perception of care, Training in management of STD/Aids, STD/Aids in BC to health, Management of HIV/Aids and Demand). The speeches of professionals revealed, on the one hand, stereotypical beliefs and biased against the person living with HIV/Aids and own illness, and on the other, the speeches referred to the importance of an effective care practice against the STD/Aids and to include that issue in the service routine. Points to the need for commitment and accountability of management, organizing the definition of priorities on the schedule of BC and ensuring the required training and inputs that have the human and material resources at FHU for working with the STD/Aids. / A resposta ao surgimento da Aids no Brasil potencializou diversas ações nos serviços de saúde, de forma a garantir o atendimento de qualidade, o diagnóstico precoce e seguro e o tratamento eficaz à população. Assim, rapidamente o SUS (Sistema Único de Saúde) passou a dar atenção às necessidades trazidas pelas demandas de DST/Aids, sendo a Atenção Básica (AB), estrategicamente, o maior espaço para a implementação de uma política de cuidado e prevenção destas, uma vez que é a porta de entrada preferencial do usuário no sistema. Neste sentido, esse estudo teve como objetivo investigar o cuidado e a prevenção acerca das DST/Aids nas Unidades de Saúde da Família (USF), a partir das crenças e das práticas dos profissionais. A partir de uma amostragem estratificada por conveniência, foram selecionadas 19 USF, localizadas na cidade de João Pessoa-PB, participando um profissional de cada USF, com idades variando de 23 a 65 anos (M=40; DP=10,63), sendo apenas um do sexo masculino. Foram utilizados três instrumentos que se complementaram: questionário estruturado, roteiro de observações e entrevista semiestruturada. Os dados do questionário e do roteiro foram analisados através de estatística descritiva, enquanto as entrevistas foram transcritas e, após, realizada uma análise categorial temática. A partir dos dados quantitativos, verificou-se que 11 USF realizam o atendimento das DST a partir de uma abordagem sindrômica, apesar de referirem que o tratamento é feito em serviços especializados, na maioria das DST. Sobre o diagnóstico, nenhuma USF oferece os testes anti-HIV, VDRL e sorologia para as Hepatites B e C. Sobre a disponibilidade de preservativo masculino, 18 USF afirmaram sempre tê-lo disponível para a população, sendo a distribuição livre em 12 delas. As populações consideradas como mais vulneráveis às DST/Aids foram as mulheres e os adolescentes/jovens, havendo, em algumas USF, atividades de prevenção junto às mesmas. A realização de atividades externas de prevenção foram referidas por 13 USF, sendo a escola o local mais citado (11 USF). Observou-se que em 9 USF os preservativos ficavam disponíveis no balcão da recepção; apenas em uma unidade havia distribuição de folhetos educativos e em 4 havia cartazes informativos sobre essa temática. Quanto aos dados qualitativos, os discursos dos profissionais apontaram para 2 classes temáticas: 1) Infecção pelo HIV (Categorias: Contágio e Indivíduo soropositivo ao HIV); e 2) Percepções e práticas no trabalho (Categorias: Percepção do cuidado, Capacitação no manejo das DST/Aids, DST/Aids na AB à saúde, Manejo do HIV/Aids e Demanda). Os discursos dos profissionais revelaram, por um lado, crenças estereotipadas e preconceituosas frente à pessoa que vive com HIV/Aids e à própria doença, e por outro, os discursos se referiam à importância de uma prática de cuidado efetiva frente às DST/Aids e da inclusão dessa temática na rotina do serviço. Aponta-se para a necessidade de maior comprometimento e responsabilização da gestão, organizando a definição de prioridades na agenda da AB e garantindo os insumos e os treinamentos necessários para que se tenham recursos humanos e materiais nas USF para se trabalhar com as DST/Aids.

BACKGROUND: More than 70% of the global premature mortality from NCDs occurs in low- and middle-income countries. These countries, including Nigeria, also have varied but mostly limited health system capacity to respond to cardiovascular disease and diabetes mellitus. Substantial gaps exist in our understanding of the subnational capacity to respond to these conditions in Nigeria. This encompasses a variety of issues, perhaps most importantly the readiness of facilities to provide care and the quality of care provided to patients with these conditions. As the Lagos State government accelerates the rollout of its mandatory state-based health insurance scheme, the number of patients with diabetes and hypertension receiving care will increase, poor management of which can threaten the scheme's financial sustainability. This mixed-methods study was conducted as part of the baseline activities of an impact evaluation of the health insurance program and was designed to answer three questions: 1) What is the capacity and readiness of health facilities in Lagos State to provide hypertension (HTN) and diabetes (DM) care? 2) What is the level of the quality of care provided to patients with HTN and DM, and how does it vary by patient and facility characteristics? 3) What are the barriers to providing diabetes and hypertension care from providers' perspectives? METHODS: The data for this study were collected using three approaches. We conducted a facility survey among public and private facilities (n=84) in Lagos State to assess facility readiness and the functionality of systems required for diabetes and hypertension care. Linear mixed-effects models were used to determine the level and factors associated with the process quality of care provided to patients in 2019 by analyzing clinical data collected via medical chart abstraction. Finally, in-depth interviews were conducted with health care providers (n=20) to explore their practices and the barriers faced in providing care to patients with diabetes and hypertension. RESULTS: The essential inputs needed for diabetes and hypertension care were mostly available; the mean HTN readiness score was 66%, and the DM readiness score was 68.9%. At the same time, systems to facilitate longitudinal care were mostly lacking; 35% had a mechanism for tracking patients who missed appointments, and 52% assigned unique patient identification numbers to NCD patients. Based on the clinical records, the quality of care provided to patients was very low; overall, patients with diabetes and hypertension received less than 30% of recommended care processes. Less than a third of the patients had their blood pressure or blood glucose controlled. There was substantial variation in the mean quality score by patient and across care processes, with lifestyle modification counseling (LSM) counseling the least likely to be delivered. According to providers, the inability to pay for laboratory tests and medications and non-compliance with medications and clinic visits are key barriers to delivery of high-quality services. Barriers at the organizational level included poorly functioning two-way referrals, non-availability of LSM counseling materials, and lack of recall and follow-up systems. CONCLUSION: While the service readiness scores for diabetes and hypertension are moderately high among these health facilities, there are critical deficits in their ability to provide long-term, integrated care of high quality to patients. Addressing these deficits will require the implementation of a comprehensive model of care co-created by providers, health system managers, patients, and insurers. Lessons can be drawn from the implementation of other chronic disease programs to kick start this process. / 2024-08-30T00:00:00Z

[pt] As transformações socioculturais no Ocidente influenciaram profundamente a família contemporânea. As mudanças no papel da mulher e o seu deslocamento para o ambiente profissional fizeram com que os cuidados realizados com crianças pequenas fossem compartilhados por outros cuidadores, como por exemplo, as babás. O objetivo da pesquisa foi identificar as práticas e crenças de cuidado infantil realizado por mães e babás de famílias nucleares, e assim, comparar tais achados. O estudo de cunho qualitativo entrevistou 15 duplas de mães e babás, com filhos de até três anos de idade. As famílias residiam na zona sul do Rio de Janeiro. Foram realizadas entrevistas semiestruturadas, contendo nove questões, além das cinco imagens referentes aos sistemas parentais de Keller (2005). A maioria das mães apresentou escolaridade superior, enquanto as babás, ensino fundamental incompleto a ensino médio completo. Os resultados demostraram que mães e babás estabeleceram ordens semelhantes para as figuras dos sistemas parentais de cuidado. Outro dado identificou 12 categorias comuns referentes à prática de cuidados infantil desempenhada por mães e babás. A maioria das cuidadoras relatou a transmissão de crenças pessoais para as crianças a partir da interação e da prática de cuidados. O trabalho concluiu que as crenças e práticas dos cuidadores são fundamentais para o desenvolvimento infantil na primeira infância. / [en] Sociocultural transformations in the West have profoundly influenced the contemporary family. Changes in the role of women and their shift to the professional environment meant that care provided to young children was shared by other caregivers, such as nannies. The objective of the research was to identify childcare practices and beliefs carried by mothers and nannies form nuclear families, and thus compare these findings. The qualitative study interviewed 15 pairs of mothers and nannies, with children up to three years old. The families lived in the south of Rio de Janeiro. Semi-structured interviews were conducted, containing nine questions, in addition to the five images referring to Keller s parental systems (2005). Most mothers had higher education, while nannies, incomplete elementary school to complete high school. The results showed that mothers and nannies established similar orders for the figures of parental care systems. Another finding identified 12 common categories referring to the practice of child care performed by mothers and nannies. Most caregivers reported the transmission of personal beliefs to children from interaction and care practice. The paper concluded that caregivers beliefs and practices are fundamental to early child development.

A descriptive quantitative study was undertaken in the Leribe and Butha-buthe northern districts of Lesotho. Thirty-six trained, twenty-four untrained TBAs and nine nurses involved in training TBAs were recruited. In line with research by Clarke and Lephoto (1989:3) the TBAs were elderly females who had children of their own. In contrast with the MOH (1993: 10) where TBAs were found to be illiterate, most (93%) of the TBAs in this study had at least a primary education. The art of primary midwifery was learned through assisting with a delivery and being taught by mothers or mothers-in-law. The public health nurses conduct formal training ofTBAs in Lesotho over a period of two weeks, where subjects like ante-natal care, delivery of the baby and post- natal care are addressed. The majority (78.8%) provide antenatal care at their homes or the home of the mother. This includes palpation, history taking, and abdominal massage and health education. An important role is identifying women at risk. During labour the progress of labour is monitored and care is given to the mother and baby post-natally. Trained TBAs could identify women at risk more readily than untrained TBAs. Cases referred most frequently were prolonged labour and retained placenta. Trained TBAs practiced hygiene more often and gave less herbs than untrained TBAs. The health care system is providing support to the TBAs through training and supervision, but was found to be inadequate. Community leaders are involved in the selection of TBAs for training. Regular meetings are held with the TB As to discuss problems. Communication is one of the problems the TB As have to face, because of the long distances from health care centres. A lack of infrastructure and supplies is also of concern. It can be concluded that TBAs play an important role in maternal health care in Lesotho and are supported to a lesser degree by the health care system, which causes problems for the TBAs in their practices. It is recommended that the ministry of health becomes more aware of the need for training TBAs and that a programme for training should be more appropriate, taking cultural practices into account. / Advanced Nursing Science / D.Lit. et Phil.