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To identify and synthesise the scientific evidence on determinants of self-care deficits in people with chronic wounds.
Scoping review based on the Joanna Briggs Institute guidelines.
This scoping review was conducted by a review team responsible for study screening, data extraction and synthesis. The categorisation of findings was grounded in Orem's Self-Care Deficit Theory and operationalised using the COM-B model and the Theoretical Domains Framework.
A comprehensive search, without date or language restrictions, was conducted in Web of Science, MEDLINE (PubMed), Cochrane Library, Scopus (Elsevier), SciELO, Ovid and EMBASE (Elsevier), from November 2023 to April 2024.
Of the 3076 records identified, 22 studies were included. Most were cross-sectional studies, with sample sizes ranging from seven to 1085 participants and a mean age of 61.45 years, predominantly involving people with venous leg ulcers and diabetic foot ulcers. Findings were synthesised into four categories: clinical, socioeconomic, behavioural and health system-related factors, indicating that multiple interrelated determinants influence engagement in self-care and contribute to persistent self-care deficits.
The findings demonstrate the vulnerability of people living with chronic wounds, arising from the complex interaction of clinical, psychosocial, socioeconomic and health service-related factors that determine self-care deficits. These deficits compromise wound healing, prolong treatment and negatively affect quality of life, underscoring the need for person-centred approaches to care.
This study reinforces the need for integrated and sustainable models of care grounded in person-centred practice, aimed at strengthening self-care capacities, enhancing clinical practice and informing more equitable health policies.
This review highlights the multifactorial nature of self-care deficits in people with chronic wounds. Nursing plays a key role in identifying barriers and strengthening capacities through Orem's supportive–educative system. Person-centred interventions improve adherence and continuity of care.
This review follows the PRISMA guidelines for reporting.
This study did not include patient or public involvement in its design, conduct, or reporting.
We aim to identify trajectories of probable maternal common mental disorders (CMD), as well as risk and protective factors associated with maternal mental health among postpartum women during the pandemic using life course theory approach.
Prospective individual level cohort study from the Iracema-COVID Study.
Mothers (n=335) at postpartum period who delivered during the COVID-19 pandemic in the fourth largest city in Brazil.
Probable CMDs were accessed using validated instruments in five cohort waves at postpartum period. Sequence analyses (SA) were employed to extract CMD trajectories, and a set of generalised binomial logistic and log-Poisson multivariable regression models with robust variance were employed to assess risk and protective factors for probable CMDs diagnosis.
Trajectories patterns of probable maternal common mental disorders.
Fit indices demonstrated a two-cluster-SA solution of probable CMD. The patterns of probable CMDs indicated that 335 mothers were clustered into occasional/transitory (n=240, 71.64%) and mostly/persistent (n=95, 28.36%) CMD trajectories. We found that mothers with low education (OR: 2.44; 95% CI 1.13 to 5.23), single (OR: 1.97; 95% CI 1.03 to 3.75) or in a stable union (OR: 2.00; 95% CI 1.02 to 3.90) and travel time spent to access the nearest primary healthcare unit (OR: 1.02; 95% CI 1.006 to 1.04) were associated with increased OR of belonging to the mostly/persistent CMD trajectory. Deprived green areas acted as a risk factor to maternal CMDs prevalence (OR: 1.37; 95% CI 1.002 to 1.87).
This study provides evidence that individual vulnerabilities and neighbourhood deprivation play an important role in understanding maternal mental health, beyond the patterns and trajectories of probable maternal CMD due to issues confronted during the COVID-19 outbreak in the northeastern region of Brazil. Policies to prevent and treat maternal mental health issues and improvement in neighbourhood deprivation need to be developed and addressed to avoid exacerbation of probable maternal CMDs.
Gestational weight gain (GWG) is an important indicator of maternal nutrition to be monitored during pregnancy. However, there is no evidence-based tool that can be used to monitor it across all geographic locations and pre-pregnancy body mass index (BMI) categories. The WHO is undertaking a project to develop GWG charts by pre-pregnancy BMI category, and to identify GWG ranges associated with the lowest risks of adverse maternal and infant outcomes. This protocol describes all the steps that will be used to accomplish the development of these GWG charts.
This project will involve the analysis of individual participant data (researcher-collected or administrative). To identify eligible datasets with GWG data, a literature review will be conducted and a global call for data will be launched by the WHO. Eligible individual datasets obtained from multiple sources will be harmonised into a pooled database. The database will undergo steps of cleaning, data quality assessment and application of individual-level inclusion criteria. Heterogeneity of maternal weight and GWG will be assessed to verify the possibility of combining datasets from multiple sources and regions into a single database. Generalized Additive Models for Location, Scale and Shape will be applied for the construction of the centile curves. Diagnostic measures, internal and external validation procedures will also be performed.
This project will include an analysis of existing study de-identified data. To be included in the pooled database, each included study should have received ethics approvals from relevant committees. Manuscripts will be submitted to open-access journals and a WHO document will be published, including the GWG charts and cut-offs for application in antenatal care.
To understand the social representations of bedside milk expression (BME) among mothers of preterm newborns in neonatal intensive care units (NICUs).
Qualitative descriptive study.
The study was conducted from July to August 2024 in two NICUs of a referral maternity hospital in Fortaleza, Brazil. Nineteen mothers of hospitalised premature newborns participated. Semi-structured interviews were conducted and subjected to thematic content analysis.
Mothers perceived BME as a meaningful act of protection and bonding, though some were unfamiliar with the practice. Emotional ambivalence was common, shaped by prior breastfeeding experiences and the context of prematurity. Discomfort related to privacy and shared spaces was noted. Support from healthcare professionals was essential to promote understanding and adherence.
Social representations of BME are shaped by emotional, social and institutional experiences. Anchored in prior breastfeeding experiences and cultural meanings of maternal care, the practice is objectified through both gestures of affection and tangible barriers.
Healthcare professionals, particularly nurses, should receive training to support mothers in BME. Structural improvements, privacy and emotional support are essential for fostering maternal autonomy and confidence.
This study highlights the barriers to BME, emphasising the role of healthcare support and the need for better infrastructure, privacy and training to enhance maternal confidence and breastfeeding.
The study followed the Consolidated Criteria for Reporting Qualitative Research checklist.
None.
This paper highlights the pivotal role of healthcare professional support in overcoming barriers to BME and promoting breastfeeding practices.
Fresh breast milk is considered the gold standard for reducing complications and improving survival in preterm infants. BME is recommended as an effective strategy to ensure the availability of fresh breast milk. Mothers' social representations of this practice remain underexplored within the neonatal intensive care context.
Explores mothers' social representations of BME in NICUs, addressing a significant gap in qualitative research. Reveals how emotional, social and institutional factors shape mothers' perceptions, motivations and challenges related to BME. Highlights the need for targeted professional support, improved infrastructure and privacy to enhance maternal autonomy and adherence to milk expression practices.
Healthcare professionals, particularly nurses, should receive specialised training to provide technical guidance and emotional support, enhancing mothers' confidence and autonomy in BME. Improving infrastructure and ensuring privacy in NICUs are crucial to creating supportive environments that facilitate milk expression and strengthen maternal–infant bonding. Institutional policies should integrate maternal-centred strategies to support breastfeeding continuity and promote humanised neonatal care.
FreshRSS 