Does parity worsen diabetes-related chronic complications in women with type 1 diabetes?

AIM: To determine the relationship between parity, glycemic control, cardiovascular risk factors and diabetesrelated chronic complications in women with type 1 diabetes.METHODS: This was a multicenter cross-sectional study conducted between December 2008 and December 2010 in 28 public clinics in 20 cities from the 4 Brazilian geographic regions. Data were obtained from 1532 female patients, 59.2% Caucasians, and aged 25.2 ± 10.6 years. Diabetes duration was of 11.5 ± 8.2 years. Patient's information was obtained through a questionnaire and a chart review. Parity was stratified in five groups: Group 0(nulliparous), group 1(1 pregnancy), group 2(2 pregnancies), group 3(3 pregnancies), group 4(≥ 4 pregnancies). Test for trend and multivariate random intercept logistic and linear regression models were used to evaluate the effect of parity upon glycemic control, cardiovascular risk factors and diabetes-related complications. RESULTS: Parity was not related with glycemic control and nephropathy. Moreover, the effect of parity upon hypertension, retinopathy and macrovascular disease did not persist after adjustments for demographic and clinical variables in multivariate analysis. For retinopathy, the duration of diabetes and hypertension were the most important independent variables and for macrovascular disease, these variables were age and hypertension. Overweight or obesity was noted in a total of 538 patients(35.1%). A linear association was found between the frequency of overweight or obesity and parity(P = 0.004). Using a random intercept multivariate linear regression model with body mass index(BMI) as dependent variable a borderline effect for parity(P = 0.06) was noted after adjustment for clinical and demographic data. The observed variability of BMI was not attributable to differences between centers.CONCLUSION: Our results suggest that parity has a borderline effect on body mass index but does not have an important effect upon hypertension and micro or macrovascular chronic complications. Future prospective evaluations must be conducted to clarify the relationship between parity, appearance or worsening of diabetesrelated chronic complications.

Guidance Guide for Caregivers of Patients with Dementia

Thinking about specialized care that respects vulnerabilities leads to a high and continuous requirement in clinical quality standards.Reflect on the problem of dementia from the perspective of the caregiver and empower caregivers in the face of the demands of having a family member with dementia are the objectives proposed.Dementia,caregiver and the nursing role,are approached from a descriptive and reflective perspective.The role of nurses specialized in mental health and psychiatry in monitoring the target individual of nursing care,based on the specific needs of the patient and the exploration of interventions and guidelines to prescribe,demonstrate that this therapeutic process is a path of change,presenting itself as a complementary method that compensates for the investments made.This structured process,which values the relationship between the professional/the target of care and the family caregivers,allows them to develop skills that allow them to continue their life path,as an adaptive way to the context of dementia.

Child Neglect and Perspectives of Nurses Specializing in Mental Health and Psychiatry in Family Violence:Clinical Case

We live in a changing society in which the family plays a role in fostering close relationships among family members,as well as the responsibility to pass on values and principles to them.When the actions of parents and other families impair the child‟s rights and needs in terms of psychomotor,intellectual,moral,emotional or relationship development,we will face situations of neglect,abuse or violence.Since these behaviors can be active(sexual,physical or psychological violence)or passive(by default,to ensure the well-being of the child).Neglect is a form of abuse that leaves the child feeling ostracized and guilty.