Repositório RCAAP

ABSTRACT Objectives: to assess the sustainability of the Breastfeeding-Friendly Primary Care Initiative by analyzing compliance with the Ten Steps in accredited units; and association with maternal satisfaction and exclusive breastfeeding. Methods: a cross-sectional study conducted in 2016. An assessment of compliance, conducted by interviews with health professionals, pregnant women, and mothers. An association between compliance and satisfaction, analyzed by Spearman›s correlation test; and association between contextual/individual characteristics and exclusive breastfeeding, by the multilevel Poisson regression. Results: compliance was 5.4-10 points and satisfaction was 36.8%-100%. Prevalence of exclusive breastfeeding was 56.7%. There was a correlation between compliance and satisfaction. Higher education, prenatal orientation, hospital discharge on exclusive breastfeeding, attendance in mixed units, and female gender of the child were associated with higher prevalence of exclusive breastfeeding; on the other hand, increasing age and pacifier use were associated with lower prevalence. Conclusions: the Initiative proved to be sustainable; compliance with the Ten Steps was high and was reflected in maternal satisfaction.

ABSTRACT Objectives: to identify the trend and factors associated with Tuberculosis-Diabetes Mellitus comorbidity in Imperatriz, Maranhão. Methods: epidemiological temporal-series study, conducted in a Northeastern Brazilian municipality. The population consisted of Tuberculosis cases with Diabetes Mellitus-associated aggravation notified in the Notifiable Diseases Information System (SINAN) between 2009 and 2018. We determined the prevalence and trend of comorbidity using Prais-Winsten regressions and to identify associated factors employed Poisson regression. Results: prevalence ranged from 3.23% in 2014 to 19.51% in 2018, with a mean of 11.5% for the period, showing an increasing trend. Age groups 30 to 59 years and ≥ 60 years, education < 8 years, and clinical form of pulmonary Tuberculosis were risk factors for comorbidity. Conclusions: The increasing trend of comorbidity and its associated factors alert us to the need to improve customer service at all levels of health care.

ABSTRACT Objectives: to analyze the self-management support needs of adolescents with type 1 diabetes mellitus. Methods: this qualitative research was carried out between September and December 2017 with nine adolescents in the pediatric outpatient clinic of a university hospital and in their homes. The material collected through semi-structured interviews was interpreted by thematic inductive analysis in the light of the healthcare management concept. Results: adolescents’ self-management support needs include longitudinal monitoring by health teams; family support in their training; support from the social network; and a careful look by government officials in the construction of guidelines for dispensing the essential inputs for treatment. However, these needs are not always met satisfactorily, resulting in gaps in this support. Final Considerations: these gaps interfere in resolving health demands. Self-care with fragmented support affects the healthcare management dimensions, making it impossible to meet the uniqueness of adolescents in a comprehensive, expanded and ethical way.

ABSTRACT Objectives: to evaluate different monitoring methods for detecting the presence of organic or biological matter before and after the cleaning and disinfection processes of the operating room. Methods: this is a cross-sectional study based on visual inspection, adenosine triphosphate levels and microbiological culture for the assessment of cleaning and disinfection. Results: 93.3% of the surfaces inspected visually for this study purpose were considered clean, even when high levels of adenosine triphosphate and microbiological analysis detected presence of microorganisms relevant to biofilm formation. Conclusions: the cleaning and disinfection processes reduced the microbial load and organic matter of the inspected surfaces, demonstrated by the values obtained by the adenosine triphosphate bioluminescence assay and microbiological analysis, but the visual inspection as a unique tool to assess the surfaces’ cleanliness may give a false impression of clean environment.

ABSTRACT Objectives: to identify the challenges to actions to contain bacterial resistance. Methods: cross-sectional study, carried out in 30 large-sized hospitals in Minas Gerais, from 2018 to 2019. The professionals were interviewed, and the environment and actions to prevent bacterial resistance were observed. Results: regarding the knowledge of health care professionals about the measures of bacterial resistance prevention, 78.3% did not correctly describe the five moments of hand hygiene, and 76.6% did not correctly describe the measures to control bacterial resistance. The simple hygiene of hands, followed by alcohol rubbing was predominant (48.3%) among workers, and soap dispensers were next to alcohol dispensers in 58.3% of the nursing stations in care units. Conclusions: the insufficient knowledge from the professionals, which is a failure related to the physical structure and to personal protection equipment, are factors that difficult the adherence to measures to contain bacterial resistance in hospitals.

ABSTRACT Objectives: to evaluate the microbial load and adherence of Escherichia coli in different areas of the surgical instrument surface exposed to experimental contamination over time. Methods: experimental study in which fragments of crile forceps (serrated, rod and rack) were contaminated by immersion in Tryptic Soy Broth, containing 106 CFU/mL of E. coli, for 1, 2, 4, 6, 8, 12 and 24 hours. Microbial load and bacterial adherence were evaluated using microbiological culture and scanning electron microscopy, respectively. Results: there was an increase in the microbial load on the surgical instrument, proportional to the contamination interval, ranging from 102 after 1 hour to 105 CFU/cm2 in 24 hours. The presence of exopolysaccharide was detected after two hours of contamination. Conclusions: microbial load and adhesion of E. coli increased over time, reaching 105 CFU/cm2 after 24 hours of contamination, starting biofilm formation after two hours.

ABSTRACT Objectives: to analyze, in the light of systemic thinking, the association between family dynamics and the use of alcohol, tobacco, and other drugs by adolescents throughout life. Methods: a cross-sectional descriptive study was conducted in nine public schools in the city of Recife. Three hundred and sixty-four adolescents aged 14 to 19 years participated. We used three questionnaires: The Alcohol, Smoking, and Substance Involvement Screening Test, a reduced version of the Drug Use Screening Inventory; and a sociodemographic questionnaire. Results: there was an association between parents/guardians ignoring what the child considers meaningful to him and the consumption of alcohol and tobacco by adolescents; we also verified an association between the occurrence of conflicting relationships and the consumption of illicit drugs by adolescents. Conclusions: it confirmed that disorganization in the family system, marked by impairments in emotional connections among members, and fragility in the sense of belonging are associated with the consumption of drugs in life by adolescents.

ABSTRACT Objectives: to evaluate the effects of venous ulcer healing in patients after six months of conventional treatment and adjuvant low-power laser therapy. Methods: prospective cohort study nested in a randomized clinical trial with 38 patients, allocated into an intervention group (conventional treatment and adjuvant laser therapy) and a control group (conventional treatment). Patients were followed up as outpatients, sociodemographic and clinical variables were collected, and indicators of the outcomes Wound healing: secondary intention (1103) and Tissue integrity: skin and mucous membranes(1101) of the Nursing Outcomes Classification. Generalized estimating equations, Kaplan-Meier tests, and robust Poisson regression were used in the analysis. Results: the clinical indicators Decreased wound size and Scar formation showed a statistically significant difference in the intervention group, higher number of healed wounds, lower rate, longer time to relapse. Conclusions: laser therapy adjuvant to conventional treatment returned better results in healing and lower recurrence rates after six months of intervention.

ABSTRACT Objectives: to understand the experience of aging in the perspective of nurses working in a hospital environment. Methods: descriptive study with a qualitative approach, with interviews based on six guiding questions analyzed through Martín Heidegger’s perspective on Phenomenology. Results: eleven nurses with a mean age of 46.2 years old participated in the study. The study unveiled the phenomenon of being a nurse in the process of aging. The speeches were divided into three categories: Being-there and the different faces of aging; Being-in-the-world of work; Being-in-the-world of old age. Final Considerations: there was a trend towards a positive search for aging and active old age, but aspects such as fear of loneliness and abandonment (“Being-in-the-world of old age”) emerged through fearful speeches. There is a need for gerontological education so that nurses can properly discuss and plan a healthy aging process and achieve a dignified old age.

ABSTRACT Objectives: to analyze the factors associated with the use of alcohol, tobacco and illicit drugs among Brazilian undergraduate students. Methods: observational, cross-sectional study, with convenience sampling, conducted in 2014/2015, involving institutional data and a self-completed online questionnaire, analyzed using measures of frequency, central tendency/dispersion and logistic regression. Results: among 126,326 students, 62.8% reported alcohol use; 11%, tobacco; and 7.5%, illicit drugs. Several academic factors-such as not residing with family (sororities [alcohol: aOR:2.38;95%CI:2.28-2.48; tobacco: AOR:2.20;95%CI:2.09-2.33; illicit drugs: AOR:2.53;95%CI:2.38-2.70]), acting in university movements (student [alcohol: AOR:1.74;95%CI:1.65-1.83; tobacco: AOR:1.97;95%CI:1.86-2.08; illicit drugs: AOR:2.43;95%CI:2.28-2.59] and religious [alcohol: AOR:0.28;95%CI:0.26-0.29; tobacco: AOR:0.23;95%CI:0.21-0.26; illicit drugs: AOR:0.18;95%CI:0.16-0.21]) and lack of discipline/study habit (alcohol: AOR:1.41;95%CI:1.37-1.45; tobacco: AOR:1.53;95%CI:1.46-1.59; illicit drugs: AOR:1.85;95%CI:1.76-1.94) - were associated with the use of the three categories of substances. Conclusions: we identified that a number of academic factors are associated with licit and illicit drug use. These findings may help in designing preventive strategies among college students.

ABSTRACT Objectives: to analyze demographic data, clinical profile and outcomes of patients in emergency services according to Manchester Triage System’s priority level. Methods: a cross-sectional, analytical study, carried out with 3,624 medical records. For statistical analysis, the Chi-Square Test was used. Results: white individuals were more advanced in age. In the red and white categories, there was a higher percentage of men when compared to women (p=0.0018) and higher prevalence of personal history. Yellow priority patients had higher percentage of pain (p<0.0001). Those in red category had a higher frequency of altered vital signs, external causes, and death outcome. There was a higher percentage of exams performed and hospitalization in the orange category. Blue priority patients had a higher percentage of non-specific complaints and dismissal after risk stratification. Conclusions: a higher percentage of altered vital signs, number of tests performed, hospitalization and death were evidenced in Manchester protocol’s high priority categories.

ABSTRACT Objectives: to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo. Methods: this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation. Results: qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke. Final Considerations: the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.

ABSTRACT Objectives: to analyze the Ethical Conciliation Hearings held by the Regional Nursing Council of São Paulo. Methods: this is a retrospective study, of a quantitative approach, with documentary analysis. To obtain the data, documents related to ethical processes were analyzed. The time frame established for the study was from January 1, 2011 to December 31, 2017. Results: 513 Ethical Conciliation Hearings were held and ratified. Nurses represent the category that most denunciate and are most accused. The highest percentages of ethical conciliations were in events related to public and hospital institutions. The Conduct Adjustment Term was the modality with the highest number of agreements. The main reason of conciliation failure was the non-attendance of at least one of the parties. Conclusions: the Ethical Conciliation Hearings represent an effective alternative instrument for the resolution of ethical-disciplinary processes in nursing.

ABSTRACT Objectives: to analyze the burden and the social support of the informal caregivers of people undergoing kidney dialysis. Methods: mixed study, based on the Theory of Stress and Overload, using instruments of sociodemographic characterization, the Social Support Survey from the Medical Outcomes Study, Zarit’s Burden Scale, and guiding questions. Analysis of data used statistical and thematic inferences. Results: 55 caregivers were evaluated, most were women, from 31 to 50 years old, married, and having worked in care for more than three years. A high level of affective and material support was observed, with a light overload on the caregiver. The central theme of the discourses was: “Experiences of the caregiver: between the burden of responsibility and the search for meaning”. Conclusions: a small overload was found in the participants, with a high median in the dimensions of affective and emotional support, in the relations between positive social interactions and the burden of the caregivers, in addition to the duality or responsibility and the meaning of care.

ABSTRACT Objectives: to propose quality indicators for clinical nursing documentation Methods: methodological study in which literature review guided the composition of an instrument for evaluating nursing documentation. Two independent professionals evaluated 204 medical records of adult patients. The analysis of this assessment generated quality indicators for clinical nursing documentation. Inter-rater agreement was analyzed by Cohen’s kappa. Results: the bibliographic review, analysis by experts and pre-test resulted in 88 evaluation items distributed in seven topics; in 88.5% of the items, inter-rater agreement between strong and almost perfect (k=0.61-1.0) was observed. Analysis of the evaluations generated a global indicator and seven partial indicators of documentation quality. Compliance in the two services ranged between 62.3% and 93.4%. The global indicator showed a 2.1% difference between services. Conclusions: seven quality indicators of clinical nursing documentation and their method of application in hospital records have been proposed.

ABSTRACT Objective: Identify the theoretical concepts that have been used in the context of nursing care for hospitalized children. Methods: Scoping review was carried out according to the PRISMA-ScR methodology. The research limitations included: primary studies dealing with the use of theoretical concepts of nursing in the provision of care to hospitalized children, access in full text, in Portuguese or English and published between 2000 and 2019. Research was carried out on grassroots platforms (EBSCOhost, PubMed, SciELO and Web of Science), gray literature and in the bibliography of selected articles. Results: 21 studies were found and 10 theoretical conceptions of nursing were identified, with family-centered care being the most used. Final considerations: The variability of the identified theoretical conceptions is emphasized, with no evidence to support the use of one in detriment of the other. A more integrative theoretical conception, which adds care centered both on the family and the child, emerges as a research trend.

ABSTRACT Objectives: to analyze the microbiological profile of leg ulcers of patients treated at outpatient clinics and hospitals regarding the type of microorganism, microbiological selection of antibiotics, and techniques for the collection of culture material. Methods: literature review performed on LILACS, IBECS, MEDLINE, and CINAHL databases, resulting in a descriptive analysis of 27 studies. Results: 35.7% of the studies occurred in an outpatient care scenario; and 64.2% in hospitals. There was a predominance of swab (100%) in outpatient care and biopsy (55.5%) in the hospital. Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were more common at both levels of assistance. Methicillin-resistant Staphylococcus aureus was isolated in both. Conclusions: the microbiological profile of infections was similar, with the presence of resistant bacteria in both environments. This fact causes concern and raises the need for research to elucidate it. The studies did not compare the effectiveness between biopsy and swab.

ABSTRACT Objectives: to analyze the impact of social protection programs on adults diagnosed with Tuberculosis. Methods: systematic review conducted by PRISMA, with registration PROSPERO CRD42019130884. The studies were identified in the VHL, PubMed, Scielo, CINAHL and Scopus databases, using the descriptors “Social Protection” and “Tuberculosis”, in combination with keywords combined with Boolean operators AND and OR. Observational and interventional studies published until October 23, 2019, in Portuguese, English and Spanish, were included. Results: social protection programs improve the treatment of tuberculosis, cure rates, adherence to treatment, the provision of services for the control of TB and reduce poverty. Conclusions: social protection programs have a positive impact on the treatment and control of people diagnosed with Tuberculosis.

ABSTRACT Objectives: to identify vulnerabilities of nurses who work in an intensive care unit. Methods: an integrative review was held from 2006 to 2019, with searches on the platforms/databases LILACS, BDENF, SciELO, MEDLINE, Scopus, CINAHL, and Web of Science. The theoretical framework of ergology, by Schwartz, was used and the guiding question “What are the main vulnerabilities of nurses who work in an intensive care unit”? Results: eleven articles were included. Five topics of vulnerabilities emerged: physical, emotional, communication process, care process, and organizational. We observed that the organizational vulnerability was kept as a common and intersection factor in developing the other four. Conclusions: vulnerabilities found have a relationship to the physical, emotional, communication, care process, and institution organization elements. The organization aspect intersected with the others, configuring itself as the core in this context.

ABSTRACT Objectives: to analyze evidence on the quality of life of people with tuberculosis/HIV coinfection. Methods: review that followed steps of the Cochrane Collaboration, with the search of publications in the bases Embase, LILACS, PubMed, and Cochrane, through the descriptors “HIV,” “Tuberculosis,” and “Quality of Life,” without a temporal cut. Results: the results include 15 studies, published between 2009 and 2019, with the level of evidence V, in its majority. It was observed that there is no uniformity in the instrument used. Psychological support to this group and strengthening of actions to manage both infections are necessary. This segment’s quality of life is associated with social factors and scientific production on the subject concentrated in underdeveloped countries. Conclusions: the articles found have a low level of scientific evidence and indicate that people who experience coinfection have a more compromised quality of life when compared to those who experience tuberculosis or HIV separately.