we highlight that the focus group, as a technique to produce data in collective space, can contribute not only to the construction of knowledge in Nursing, but also to the research approach with the assistance practice.

The aim of this study was describing and reflecting about the aspects related to the social history and public policies for the children's health assistance in Brazil. A brief historical contextualization was realized concerning changes on the way the society views the child in Brazil and around the world, also perspectives considering public policies for the children's health in the national context were presented. It was possible to identify that the historical evolution of the child participation in the society is linked to the changes in the assistance public policies, which were demonstrated in the child death decrease and associated to challenges, like the morbimortality reduction caused by perinatal injuries and avoidable causes. The advances and conquers in the child's health are evolved in a paradigmatic change movement into a model of a net formation and a comprehensiveness care. This context requires the human resources preparation for such area, based on the health promotion and prevention, as well as a better quality of life of the population.

No abstract

Objective To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions. Design Systematic review of randomised and non-randomised controlled trials. Data sources Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature. Study selection Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome. Data extraction and synthesis Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials. Results 24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05). Conclusions These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care. Systematic review registration PROSPERO CRD42018107099.

A demanda de cuidados às crianças com necessidades especiais de saúde promove desgaste físico e mental da cuidadora. Para analisar as implicações dessas demandas sobre o empoderamento da cuidadora, desenvolveu-se uma pesquisa qualitativa. Onze cuidadoras acompanhantes, de um hospital do sul do Brasil, foram organizadas em três grupos, entre 2004-2005. Utilizou-se a análise de discurso no relatório de três dinâmicas do método criativo-sensível. O empoderamento individual das cuidadoras foi construído no enfrentamento das situações-limites dos cuidados e no encontro com os profissionais de saúde. O papel de boa mãe e de cuidadoras dedicadas, abnegadas levou-as a abdicar de sua condição feminina, gerando isolamento social, sofrimento e estresse. O empoderamento individual opressivo as distanciou do empoderamento coletivo libertador; a cuidadora foi valorizada em sua condição materna e não na feminina. As práticas de empoderamento individual, centradas na abnegação e dedicação, possibilitam a reflexão e ação no processo de empoderamento coletivo.

As questões atuais relacionadas com a saúde da mulher visam atingir um novo enfoque de integralidade capaz de sobrepor os efeitos limitantes de um modelo biomédico em saúde, sem considerar os aspectos vivenciais e culturais das mulheres e suas famílias. Este estudo objetivou compreender a influência do contexto cultural no desenvolvimento da gestação e no cuidado ao bebê de mulheres mães de recém-nascidos de risco. Trata-se de estudo exploratório-descritivo, desenvolvido a partir de entrevistas com puérperas internadas em uma maternidade no sul do Brasil. Após análise temática dos dados, emergiram duas categorias principais: contexto sociocultural influenciando o período gestacional e os saberes populares no cuidado com o bebê. Os resultados apontaram que não houve, na maioria das vezes, a compreensão da mulher em seu todo, sua visão de mundo e sua maneira de pensar, sentir e agir. Nas questões de conflito, o conhecimento profissional prevaleceu sobre o popular.

Resumo O estudo teve como objetivo elaborar a versão brasileira do instrumento

Low birth weight is considered the most influentialfactor in determining neonatal morbidity and mortality. Also it may be associated with low levels of socioeconomic development and maternal and child care. This quantitative research aims to describe the risk factors for low birth weight newborns in public hospitals in the city of Santa Maria, Rio Grande do Sul Brazil. Quantitative data were analyzed using descriptive statistics. The results suggest the main risk factors are: the preterm birth,family income below - two minimum salaries, nulliparity and multiparity, the occurrence of previous abortion, surgery delivery, infections, pre-eclampsia and a history of other children of low weight. It is recommended to invest in the quality of prenatal care, since many of these risk factors can be avoided or minimized by prenatal care quality.