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      Necessidade de informação a pais de crianças portadoras de cardiopatia congênita Translated title: Need of information for parents with children suffering from congenital heart defects

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          Abstract

          INTRODUÇÃO: a equipe de enfermagem deve informar pais de crianças portadoras de cardiopatias no que diz respeito às necessidades decorrentes desta situação. As necessidades mais comuns são: informações a respeito da própria cardiopatia, promoção de atividade física, adequação da alimentação, cuidado à saúde bucal, prevenção da endocardite infecciosa, cuidados nas crises de cianose e na administração de fármacos. OBJETIVO: caracterizar o quanto pais de crianças portadoras de cardiopatia congênita estão informados acerca desta. MÉTODO: mapeamento sistemático de literatura nas bases MEDLINE, Cochrane, CINAHL, LILACS e SciELO, do período de 1997 a 2007 com obtenção de 17 artigos. RESULTADOS: há necessidades pouco exploradas: cuidados por ocasião de crise de cianose, promoção de atividade física e administração de fármacos. As demais concentram a maior parte dos estudos. No entanto, mesmo nestas percebe-se que o conhecimento dos pais é incompleto e fragmentado, e isto ocorre tanto em países desenvolvidos, quanto nos em desenvolvimento. Em sua maior parte os cuidados são prestados por enfermeiros, dentistas e médicos. Programas de capacitação de pais são poucos e apenas um é descrito como exitoso. Há imperiosa necessidade de mudanças em termos de reorganização dos serviços de modo a abranger capacitação e apoio aos pais. Além disto, é necessário validar programas e protocolos de cuidados destinados a promover a capacitação destes. Tais programas devem ser flexíveis de modo a possibilitar a adaptação a cada situação clínica e aos determinantes sociais, cultural e econômico que agem sobre a família.

          Translated abstract

          INTRODUCTION: the nursing staff must inform parents with children suffering from congenital heart defects regarding their needs related to this situation. The most common needs are the seven, as follows: Information related to cardiopathy, promotion of physical activities, adequate diet, care with buccal health, prevention of infectious endocarditis, care during cyanosis crisis and drug administration. OBJECTIVE: to characterize how much information these parents have regarding this disorder. METHOD: systematic mapping on the literature in MEDLINE, Cochrane, CINAHL, LILACS and SciELO databases, from 1997 to 2007, obtaining 17 papers. RESULTS: the following needs, cyanosis crisis, promotion of physical activities and drug administration, were not adequately studied. The majority amongst the 17 papers was concentrated on the remaining four needs. Beside this, parent's knowledge is not satisfactory and is fragmented. It happens either in developed countries as well as in the underdeveloped ones. In general, care is performed by nurses, dental physicians and physicians. Training programs for parents are scarce and only one is described as successful. Changes are mandatory in terms of reorganization of services involving training and support for parents. Besides, validation of programs and protocols of care to promote training and development is required. These programs must be flexible to allow adaptation to clinical situation and to social, cultural and economic determinant factors acting on the family.

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          Knowledge, attitudes and status of oral health in children at risk for infective endocarditis.

          The purpose of this study was to assess the oral health status of 104 children (2-17 years of age) at risk for infective endocarditis attending the Paediatric Cardiology Service of the Martagão Gesteira Institute of Child Care and Paediatrics, Rio de Janeiro, Brazil, and their guardians' attitudes towards and knowledge about endocarditis risks. A structured interview was carried out with guardians and an oral examination was performed on each child to determine scores for the plaque index (PI), gingival index (GI) and dmft/DMFT index. The percentage of guardians who understood the meaning of 'heart infection' was 9.6%, who knew the possibility of heart disease caused by dental procedures was 60.6%, who understood the requirement for antibiotic cover before dental treatment was 72.1%, and who understood the importance of good oral health to prevent infective endocarditis was 41.3%. As regards oral health behaviours, 46.1% of children brushed their teeth three times or more a day, 28.8% had never visited a dentist before, and only 24.3% attended the dentist for prevention. There was visible plaque in 98% and gingival bleeding in 99% of children in this study. The caries experience for primary dentition (dmft) was 2.62%, and 3.97 for permanent dentition (DMFT). Based on these results, we can conclude that the guardians' knowledge and attitudes about oral health were not good. This group at risk has poor oral health, which may give rise to a frequent bacteraemia under physiological conditions.
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            The experiences with oral health and dental prevention of children with congenital heart disease.

            To examine the degree to which children, considered to be at risk from infective endocarditis, had received professional education and preventive procedures in regard to dental health, and to evaluate the knowledge of their parents of the link between oral health and infective endocarditis. Questionnaires were distributed to the families of 38 children under the care of paediatric cardiology. A short dental examination was carried out. Parents were asked if they knew why oral health was of particular importance in their child. Of the children, 58% demonstrated evidence of previous or current dental disease, with 24% having had at least one filling, 13% with one or more teeth showing deficiency of enamel, and 39% with untreated dental caries. Only 79% of the children were registered with a dentist. According to Chi squared test, there was no difference in the dental health of registered and non registered children. Of the study group, 29% had received instruction in oral hygiene, 42% had received dietary advice, 13% had received advice regarding fluoride supplementation or had had fluoride professionally applied, and 8% had had fissure sealants. These percentages remained relatively low even if only registered children, or only registered children with previous or current dental disease, were considered. Only 64% of parents were aware of the link between the oral health of their children and infective endocarditis. Parents of children who were registered were more likely to be aware of this link than parents of children who were not registered. In spite of being registered with general dental practitioners, few children with congenital heart disease had received basic education in dental hygiene. Even children known to have had dental disease and, therefore, considered to be more vulnerable, were overlooked.
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              Parents' understanding of their child's congenital heart disease.

              To assess parents' understanding of their child's congenital heart disease in various knowledge domains and to identify significant determinants of parental knowledge. Cross sectional questionnaire survey Tertiary paediatric cardiac centre. 156 parents of children with relatively simple congenital heart defects were recruited from the outpatient clinic of a tertiary cardiac centre over a three month period. The questionnaire comprised 10 items of knowledge under three domains: nature of heart disease and its treatment; impact of heart disease on exercise capacity; and infective endocarditis and its prevention. The frequency distribution of the parents' knowledge in the different domains was determined. Univariate analyses and logistic regression were performed to identify significant determinants of knowledge in selected items. While 59% of parents correctly named their child's congenital heart disease, only 28.8% correctly indicated the heart lesion(s) diagrammatically. However, more than 80% of parents were aware of the indications and aims of previous surgical and transcatheter interventions. About half of the parents were aware of possible aetiologies and of the hereditary nature and symptoms attributable to underlying heart disease. Disappointingly, of the 56 parents whose children were taking cardiac medications, only 25 (44.6%) and 4 (7.1%) knew correctly the functions and important side effects of the medications, respectively. With regard to exercise capacity, 59% of parents indicated its level appropriate for the heart lesion. While 26.9% of parents had heard of the term "infective endocarditis", slightly more than half of the parents were aware of the need for antibiotics before dental procedures. Significant determinants of knowledge in the nature of heart disease were cardiac diagnosis, occupation of parents, and their educational level. Logistic regression failed to identify any significant determinants of parental knowledge in the other two domains. Parents of children with congenital heart disease have important knowledge gaps. Our findings suggest that the current educational programme is inadequate and needs to be refined to promote better parental understanding of their child's heart disease, with the ultimate aim of enabling parents to impart such knowledge accurately to their children.
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                Author and article information

                Journal
                rbcdh
                Journal of Human Growth and Development
                J. Hum. Growth Dev.
                Centro de Estudos de Crescimento e Desenvolvimento do Ser Humano (Santo André, SP, Brazil )
                0104-1282
                2175-3598
                April 2009
                : 19
                : 1
                : 103-113
                Affiliations
                [02] orgnameUniversidade de São Paulo orgdiv1Hospital das Clinicas orgdiv2Faculdade de Medicina
                [03] orgnameUniversidade de São Paulo orgdiv1Departamento de Enfermagem Materno-infantil e Psiquiátrica orgdiv2Escola de Enfermagem
                [01] orgnameUNIP orgdiv1Departamento de Enfermagem Pediátrica
                Article
                S0104-12822009000100011 S0104-1282(09)01900111
                253cdb9d-96eb-49de-b0c9-c139f8c383d5

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 07 January 2009
                : 15 November 2008
                : 08 February 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 11
                Product

                SciELO Periódicos Eletrônicos em Psicologia

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                Pesquisa Original

                family,cardiopatias congênitas,cuidado da criança,enfermagem pediátrica,família,congenital heart defects,child care,paediatric nursing

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