Abstract Background: Neuromuscular electrical stimulation seems to be a promising option to intensify the rehabilitation and improve the exercise capacity of patients in the immediate postoperative period of cardiac surgery. Objective: This study aimed to evaluate the hemodynamic (heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure) and respiratory (respiratory rate and oxygen saturation) responses to neuromuscular electrical stimulation in the immediate postoperative period in patients submitted to cardiac surgery and to verify its feasibility and safety. Methods: This is a pilot randomized controlled trial, wherein critical patients in the immediate postoperative period of cardiac surgery were randomly assigned to a control group, using sham neuromuscular electrical stimulation, or an experimental group, submitted to neuromuscular electrical stimulation sessions (FES), for 60 min, with a 50-Hz frequency, 200-µs pulse duration, time on: 3 s, and time off: 9 s. Data distribution was evaluated by the Shapiro-Wilk test. The analysis of variance was used and a p-value < 0.05 was considered significant. Results: Thirty patients were included in the study. The neuromuscular electrical stimulation was applied within the first 23.13 ± 5.24 h after cardiac surgery, and no changes were found regarding the hemodynamic and respiratory variables between the patients who underwent neuromuscular electrical stimulation, and those in the control group. Conclusions: In the present study, neuromuscular electrical stimulation did not promote changes in hemodynamic and respiratory responses of patients in the immediate postoperative period of cardiac surgery.

Resumo Objetivo Sintetizar as informações sobre os fatores associados à manutenção da amamentação por 12 meses ou mais. Fontes de dados Foi conduzida revisão sistemática nas bases de dados Pubmed/Medline, Scielo e Lilacs, inclusive artigos publicados em língua portuguesa ou inglesa desde 2004 sobre fatores associados à amamentação por, no mínimo, 12 meses. Excluíram-se artigos de revisão e com delineamento qualitativo. Os fatores foram organizados em quatro níveis de acordo com a proximidade cronológica com o desfecho: distal, intermediário distal, intermediário proximal e proximal; nacionalidade e local/área de residência foram considerados fatores contextuais. Síntese dos dados Identificaram-se 1.174 artigos, dos quais 19 foram selecionados para revisão, sete estudos de coorte e 12 transversais. Dos 75 fatores explorados, 39 mostraram-se associados ao desfecho ao menos uma vez. Os fatores com os maiores percentuais de associações com a manutenção da amamentação por 12 meses ou mais, considerando o número de vezes que foram testados, foram: filhos terem os pais como cuidadores (100%), algum tipo de exposição materna ao fumo (54%), crianças e/ou pais serem imigrantes/estrangeiros (50%), morar em zona urbana (42,9%), maior idade materna (40%), mãe ser casada (37,5%), maior escolaridade materna (31,3%), maior número de filhos (30,8%) e menor renda familiar (30%). Conclusões A manutenção da amamentação por 12 meses ou mais está associada a múltiplos fatores, com destaque para os fatores contextuais e os relacionados a algumas características sociodemográficas das mães. As associações diferem em efeito e magnitude entre as diferentes populações estudadas.

Abstract Objective Synthesize the information about the factors associated with maintenance of breastfeeding for 12 months or more. Data source A systematic review was conducted in the Pubmed/Medline, Scielo, and Lilacs databases, including articles published in Portuguese or English since 2004 on the factors associated with breastfeeding maintenance for at least 12 months; review articles and those with qualitative design were excluded. The factors were organized into four levels, according to the chronological proximity to the outcome: distal, distal intermediate, proximal intermediate, and proximal; nationality and place/area of residence were considered contextual factors. Summary of data 1174 articles were identified, of which 19 were included in this review, comprising seven cohort studies and 12 cross-sectional studies. A total of 39 of the 75 assessed factors were associated with the outcome at least once. The factors with the highest percentages of associations with maintenance of breastfeeding for 12 months or more, considering the number of times they were tested were: children whose parents are the caregivers (100%), none type of maternal exposure to smoke (54%), children and/or parents are immigrants/foreigners (50%), live in urban areas (42.9%), older maternal age (40%), married women (37.5%), higher level of maternal education (31.3%), greater parity (30.8%), and lower income (30%). Conclusions The maintenance of breastfeeding for 12 months or more is associated with multiple factors, emphasizing the contextual factors and those related to some maternal sociodemographic characteristics. Associations differ in effect and magnitude between the different populations studied.